Healthcare Provider Details

I. General information

NPI: 1689119240
Provider Name (Legal Business Name): KERI J MARACCHINI MS, RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7850 JEFFERSON ST NE STE 300
ALBUQUERQUE NM
87109-4314
US

IV. Provider business mailing address

7239 WASILLA DR NE
RIO RANCHO NM
87144-5391
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-1114
  • Fax:
Mailing address:
  • Phone: 505-615-7920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD-0991
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: