Doctor Name: | MISS RAMONA J FASULA |
NPI Number: | 1518227891 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CHHC |
License Number: | |
Business Practice Address: | 910 Providence Rd Secane, PA - 190183640 |
Business Phone Number: | 6105133541 |
Business Fax Number: | |
Mailing Address: | 910 Providence Rd, SECANE |
State: | PA |
Postal Code: | 190183640 |
Phone Number: | 6105133541 |
Fax Number: | |
NPI Enumeration Date: | 05/21/2012 |
NPI Last Update Date: | 05/21/2012 |
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: |