Basic Information
| Provider Information | |||||||||
| NPI: | 1548633449 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUSSEAU | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | E | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 HYGEIA DR | ||||||||
| Address2: | SUITE 2300 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132049 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 190 SALEM CHURCH RD | ||||||||
| Address2: | CHRISTIANA HIGH SCHOOL WELLNESS CENTER | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024545421 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2015 | ||||||||
| LastUpdateDate: | 11/02/2015 | ||||||||
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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 | DN-0000598 | DE | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.