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General NPI Number Information
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NPI Number | 1821328758
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Entity Type | Individual
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Provider Name | MARY ELIZABETH DEGNAN MS RD
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Gender | Female
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Dates
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Enumeration Date | 12/24/2009
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 621 10TH ST
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City | NIAGARA FALLS
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State | NY
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Zip | 14301-1813
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Country | US
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Telephone | 716-278-4360
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Fax | 716-278-4266
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Provider Business Mailing Address
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Address Line | 176 B HIGHLAND DRIVE
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-1235
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Country | US
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Telephone | 716-957-2285
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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 | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | 007089
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License Number State | NY
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