Doctor Name: | MS. DENISE K. BOUTWELL |
NPI Number: | 1033343785 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LICENSED DIETITIAN |
License Number: | LD003359 |
Business Practice Address: | 2501 N Patterson St Valdosta, GA - 316021735 |
Business Phone Number: | 2292594997 |
Business Fax Number: | 2292594925 |
Mailing Address: | 2501 N Patterson St, VALDOSTA |
State: | GA |
Postal Code: | 316021735 |
Phone Number: | 2292594997 |
Fax Number: | 2292594925 |
NPI Enumeration Date: | 05/11/2009 |
NPI Last Update Date: | 05/11/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | LD003359 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | |
Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |