Healthcare Provider Details

I. General information

NPI: 1790239655
Provider Name (Legal Business Name): DEBBIE LYNN MATHIEU LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

773 YORK AVE
PAWTUCKET RI
02861-2812
US

IV. Provider business mailing address

773 YORK AVE
PAWTUCKET RI
02861-2812
US

V. Phone/Fax

Practice location:
  • Phone: 401-339-7828
  • Fax:
Mailing address:
  • Phone: 401-339-7828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number00333
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: