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General NPI Number Information
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NPI Number | 1275728578
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Entity Type | Individual
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Provider Name | DEBORAH SUSAN DEPASTINA RD, LD
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Gender | Female
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 18TH MEDCOM
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City | APO
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State | SEOUL
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Zip | 96205
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Country | KP
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Telephone | 814-327-6252
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Fax |
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Provider Business Mailing Address
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Address Line | 207 LINCOLN AVE
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City | HOLLIDAYSBURG
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State | PA
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Zip | 16648-1311
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Country | US
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Telephone | 814-327-6252
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DT03881
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License Number State | TX
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