Healthcare Provider Details

I. General information

NPI: 1003403726
Provider Name (Legal Business Name): ALLIE FOLEY RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 WYOMING ST
DAYTON OH
45409-2741
US

IV. Provider business mailing address

4849 CELADON AVE
FAIRFIELD OH
45014-1749
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-2007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.09277
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: