Healthcare Provider Details

I. General information

NPI: 1841347846
Provider Name (Legal Business Name): DEBBIE ANN O'DONOHUE M.S., R.D., C.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 52 SWAN LAKE
SWAN LAKE NY
12783
US

IV. Provider business mailing address

PO BOX 465
WURTSBORO NY
12790-0465
US

V. Phone/Fax

Practice location:
  • Phone: 845-292-6875
  • Fax:
Mailing address:
  • Phone: 845-699-6366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number001487
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number001487
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: