Healthcare Provider Details

I. General information

NPI: 1174633770
Provider Name (Legal Business Name): DONNA COX MATHERNE MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMMANDER, USA MEDDAC WUERZBURG, UNIT 26610 ATTN: NUTRITION CARE DIVISION/ DONNA MATHERNE
APO AE
09244
US

IV. Provider business mailing address

USAMEDDAC WUERZBURG ATTN: CREDENTIALS UNIT 26610
APO AE
09244
DE

V. Phone/Fax

Practice location:
  • Phone: 011499318042375
  • Fax:
Mailing address:
  • Phone: 011499318043616
  • Fax: 011499318043241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1038
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: