Basic Information
| Provider Information | |||||||||
| NPI: | 1447277041 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EDWARDS | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | LYNNE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RD, LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 702 PARK ST | ||||||||
| Address2: | |||||||||
| City: | DECORAH | ||||||||
| State: | IA | ||||||||
| PostalCode: | 521012034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633824676 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 909 W 1ST ST | ||||||||
| Address2: | COMMUNITY MEMORIAL HOSPITAL | ||||||||
| City: | SUMNER | ||||||||
| State: | IA | ||||||||
| PostalCode: | 506741203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5635783275 | ||||||||
| FaxNumber: | 5635783279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.