Healthcare Provider Details

I. General information

NPI: 1649586793
Provider Name (Legal Business Name): MARYANN EASTEP MS,RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 ODESSA WAY
NEWARK DE
19711-4130
US

IV. Provider business mailing address

206 ODESSA WAY
NEWARK DE
19711-4130
US

V. Phone/Fax

Practice location:
  • Phone: 302-737-6413
  • Fax: 302-737-6413
Mailing address:
  • Phone: 302-737-6413
  • Fax: 302-737-6413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberDN-0000400
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN-000040
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDN-0000400
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: