Provider Demographics
NPI:1902945397
Name:NOVEMBRINO, DEANA MARIE (MS, RD, CD)
Entity Type:Individual
Prefix:MS
First Name:DEANA
Middle Name:MARIE
Last Name:NOVEMBRINO
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1494
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-1494
Mailing Address - Country:US
Mailing Address - Phone:803-876-7135
Mailing Address - Fax:
Practice Address - Street 1:214 CEDAR LN
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-4036
Practice Address - Country:US
Practice Address - Phone:803-876-7135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT074-0000227133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered