Provider Demographics
NPI:1952387508
Name:NELSON, DEBORAH LUCIENNE (RD, CNSD)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LUCIENNE
Last Name:NELSON
Suffix:
Gender:F
Credentials:RD, CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 MUNICIPAL DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95838-2061
Mailing Address - Country:US
Mailing Address - Phone:916-703-3110
Mailing Address - Fax:916-703-3118
Practice Address - Street 1:2315 STOCKTON BLVD
Practice Address - Street 2:RM 0102
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-703-3110
Practice Address - Fax:916-703-3118
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
852990133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA009054OtherPI