Healthcare Provider Details

I. General information

NPI: 1821280306
Provider Name (Legal Business Name): MARY E NAVARRA MNT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 WASHINGTON ST
WATERTOWN NY
13601-4034
US

IV. Provider business mailing address

830 WASHINGTON ST
WATERTOWN NY
13601-4034
US

V. Phone/Fax

Practice location:
  • Phone: 315-785-4667
  • Fax:
Mailing address:
  • Phone: 315-785-4667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number002899
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: