Provider Demographics
NPI:1902172794
Name:LANDRY, DONNA BRYANT (RD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:BRYANT
Last Name:LANDRY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 WELLINGTON AVE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6123
Mailing Address - Country:US
Mailing Address - Phone:970-298-7106
Mailing Address - Fax:970-298-7177
Practice Address - Street 1:710 WELLINGTON AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6123
Practice Address - Country:US
Practice Address - Phone:970-298-7106
Practice Address - Fax:970-298-7177
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
883605133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered