Doctor Name: | MARY KOCH |
NPI Number: | 1164848115 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 32648DI-0 |
Business Practice Address: | 801 E Williams Ave Fallon, NV - 894063052 |
Business Phone Number: | 7758677086 |
Business Fax Number: | |
Mailing Address: | 525 W Brown Rd, MESA |
State: | AZ |
Postal Code: | 852013202 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/14/2014 |
NPI Last Update Date: | 03/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | 32648DI-0 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NV |
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 |