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General NPI Number Information
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NPI Number | 1649993916
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Entity Type | Individual
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Provider Name | MARCELLA A DOUCET MS, RD, LDN
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Gender | Female
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Dates
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Enumeration Date | 09/22/2022
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Last Update Date | 10/29/2023
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Provider Practice Location Address
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Address Line | 11630 S KEDZIE AVE
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City | MERRIONETTE PARK
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State | IL
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Zip | 60803-6302
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Country | US
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Telephone | 708-438-8032
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Fax | 708-389-9088
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Provider Business Mailing Address
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Address Line | 11630 S KEDZIE AVE
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City | MERRIONETTE PARK
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State | IL
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Zip | 60803-6302
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Country | US
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Telephone | 708-438-8032
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Fax | 708-389-9088
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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 | 133VN1005X
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Taxonomy Name | Renal Nutrition Registered Dietitian
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License Number | 37003501A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 133VN1005X
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Taxonomy Name | Renal Nutrition Registered Dietitian
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License Number | 164.008601
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License Number State | IL
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