Leslie Deforest Ivey RD, LD

NPI 1104136845 - Dietitian, Registered - 133V00000X

NPI Details
NPI 1104136845
Gender Female
Enumeration Date 10/15/2010
Last Updated 10/15/2010
Entity Type Individual
Active Over 6 years ago
Practice Location
3000 N. IH35
SUITE #770
AUSTIN TX, 78705, US
Phone (512) 482-8880
Fax (512) 482-8862
Business Location
3000 N. IH35
SUITE #770
AUSTIN TX, 78705, US
Phone (512) 482-8880
Fax (512) 482-8862
Toxanomy
Taxonomy Code 133V00000X
License State Texas
License Number DT05853
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According to our database, Mrs. Leslie Deforest Ivey RD, LD NPI is 1104136845, taxonomy code is 133V00000X and license number is DT05853, license state is located at Texas. Leslie Deforest Ivey RD, LD physically located at 3000 N. Ih35, Austin TX, 78705. NPI Number Leslie Deforest Ivey RD, LD has the Individual type.

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1104136845 NPI number is provided on an as is basis without warranty of any kind. 1104136845 is maintained by the National Plan & Provider Enumeration System. The contents of Leslie Deforest Ivey RD, LD are for informational purposes only.