Healthcare Provider Details

I. General information

NPI: 1366984296
Provider Name (Legal Business Name): MARLEA FINCH MS RD LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 N HANLEY RD
BERKELEY MO
63134-2003
US

IV. Provider business mailing address

6121 NORTH HANLEY RD
ST. LOUIS MO
63134
US

V. Phone/Fax

Practice location:
  • Phone: 314-615-0557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2016014889
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: