Basic Information
| Provider Information | |||||||||
| NPI: | 1962467928 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ONKS | ||||||||
| FirstName: | MAVIS | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RD,LDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 450 MOUNTAIN LIGHT LN | ||||||||
| Address2: | |||||||||
| City: | UNICOI | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376924772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239261171 | ||||||||
| FaxNumber: | 4239793402 | ||||||||
| Practice Location | |||||||||
| Address1: | FIRST STREET BLD 200 BOX 4000 | ||||||||
| Address2: | JAMES H QUILLEN VAMC(120B) | ||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376844000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239261171 | ||||||||
| FaxNumber: | 4239793402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 00121 | TN | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.