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General NPI Number Information
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NPI Number | 1275958332
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Entity Type | Organization
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Legal Business Name | VASSAR-SHERMAN LLC
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Dates
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Enumeration Date | 02/26/2014
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Last Update Date | 10/03/2014
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Provider Practice Location Address
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Address Line | 110 S BOLIVAR ST STE 102
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City | MARSHALL
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State | TX
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Zip | 75670-4184
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Country | US
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Telephone | 903-472-4975
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Fax | 903-472-4977
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Provider Business Mailing Address
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Address Line | 110 S BOLIVAR ST STE 102
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City | MARSHALL
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State | TX
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Zip | 75670-4184
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Country | US
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Telephone | 903-472-4975
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Fax | 903-472-4977
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Authorized Official
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Title or Position | OWNER
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Name | MARY LYNN VASSAR
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Credential | RD
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Telephone | 903-472-4975
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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 | DT03384
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License Number State | TX
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