Healthcare Provider Details

I. General information

NPI: 1811233992
Provider Name (Legal Business Name): MARISSA TESTA MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARISSA DEAN

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1842 MERGANSER RUN DR
COLUMBUS OH
43215-7017
US

IV. Provider business mailing address

1842 MERGANSER RUN DR
COLUMBUS OH
43215-7017
US

V. Phone/Fax

Practice location:
  • Phone: 614-946-8709
  • Fax:
Mailing address:
  • Phone: 614-946-8709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD 7102
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number7102
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number7102
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: