Provider Demographics
NPI:1811313463
Name:MARCIA PELL CDE RDN LDN LLC
Entity type:Organization
Organization Name:MARCIA PELL CDE RDN LDN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-867-0336
Mailing Address - Street 1:2337 JUDSON ST
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-3018
Mailing Address - Country:US
Mailing Address - Phone:850-867-0336
Mailing Address - Fax:888-975-7696
Practice Address - Street 1:2337 JUDSON ST
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-3018
Practice Address - Country:US
Practice Address - Phone:850-867-0336
Practice Address - Fax:888-975-7696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-06
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3263133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty