| Doctor Name: | MS. STEPHANIE FLEETWOOD DEIVERT |
| NPI Number: | 1609823087 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.D. |
| License Number: | DN003387 |
| Business Practice Address: | 675 Baltimore Dr Wilkes Barre, PA - 187027900 |
| Business Phone Number: | 5708085757 |
| Business Fax Number: | 5708086356 |
| Mailing Address: | 100 N Academy Ave, Credentials Dept DANVILLE |
| State: | PA |
| Postal Code: | 178224903 |
| Phone Number: | 5702716144 |
| Fax Number: | |
| NPI Enumeration Date: | 05/30/2006 |
| NPI Last Update Date: | 06/22/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | DN003387 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| 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 |