Healthcare Provider Details

I. General information

NPI: 1790052561
Provider Name (Legal Business Name): DANIELLE ALENA DEMARCO MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N EWING ST
LANCASTER OH
43130-3372
US

IV. Provider business mailing address

401 N EWING ST
LANCASTER OH
43130-3372
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-8468
  • Fax: 740-687-8365
Mailing address:
  • Phone: 740-687-8468
  • Fax: 740-687-8365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number6880
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: