Healthcare Provider Details

I. General information

NPI: 1699298927
Provider Name (Legal Business Name): PARIS DELANI ROBBINS RD,LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MARSHALL ST
CHARLESTON MO
63834-1336
US

IV. Provider business mailing address

1200 E MARSHALL ST
CHARLESTON MO
63834-1336
US

V. Phone/Fax

Practice location:
  • Phone: 573-683-2191
  • Fax: 573-683-6539
Mailing address:
  • Phone: 573-683-2191
  • Fax: 573-683-6539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2017038902
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: