Healthcare Provider Details

I. General information

NPI: 1275628067
Provider Name (Legal Business Name): FERAL IVY STERLING MPH, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W. FIFTH STREET
LAPLACE LA
70068
US

IV. Provider business mailing address

4704 SPAIN ST
NEW ORLEANS LA
70122-5031
US

V. Phone/Fax

Practice location:
  • Phone: 985-652-2190
  • Fax:
Mailing address:
  • Phone: 504-451-6373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1169
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: