Healthcare Provider Details

I. General information

NPI: 1689807513
Provider Name (Legal Business Name): MARCIA DEUERLING R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 N SAINT JOSEPH AVE
NILES MI
49120-2207
US

IV. Provider business mailing address

31 N SAINT JOSEPH AVE
NILES MI
49120-2207
US

V. Phone/Fax

Practice location:
  • Phone: 269-683-5510
  • Fax: 269-683-9113
Mailing address:
  • Phone: 269-683-5510
  • Fax: 269-683-9113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: