Doctor Name: | DEANNA ANTONOW |
NPI Number: | 1114036035 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 1537 Elmira St Sayre, PA - 188409254 |
Business Phone Number: | 5708886803 |
Business Fax Number: | |
Mailing Address: | Rd2 Box335, ROME |
State: | PA |
Postal Code: | 18837 |
Phone Number: | 5702472749 |
Fax Number: | |
NPI Enumeration Date: | 08/30/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133NN1002X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Nutritionist |
Taxonomy Specialization: | Nutrition, Education |
Taxonomy Definition: |