Healthcare Provider Details

I. General information

NPI: 1942331129
Provider Name (Legal Business Name): MARLEEN DYKHUIS MA, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 TUTU PARK MALL STE 207
ST THOMAS VI
00802-1736
US

IV. Provider business mailing address

PO BOX 7846
ST THOMAS VI
00801-0846
US

V. Phone/Fax

Practice location:
  • Phone: 340-513-7783
  • Fax:
Mailing address:
  • Phone: 340-513-7783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number727852
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: