Provider Demographics
NPI:1902526601
Name:DUFF, MARY ANN (RDN, LDN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:DUFF
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:SNYDER
Other - Last Name:DUFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDN, LDN
Mailing Address - Street 1:5814 S NORTHERN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-1976
Mailing Address - Country:US
Mailing Address - Phone:417-848-0259
Mailing Address - Fax:
Practice Address - Street 1:OZARKS DIALYSIS SERVICES
Practice Address - Street 2:3525 S. NATIONAL AVE, SUITE 108
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807
Practice Address - Country:US
Practice Address - Phone:417-269-8736
Practice Address - Fax:417-269-3471
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000175375133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
803062OtherREGISTERED DIETITIAN