Healthcare Provider Details

I. General information

NPI: 1457517286
Provider Name (Legal Business Name): DEBBIE MERI VERKIN-SIEBERT R.D.,L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 N MARTIN WILLISTON RD
GENOA OH
43430-9451
US

IV. Provider business mailing address

1585 N MARTIN WILLISTON RD
GENOA OH
43430-9451
US

V. Phone/Fax

Practice location:
  • Phone: 419-410-7196
  • Fax:
Mailing address:
  • Phone: 419-410-7196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number603
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: