Provider Demographics
NPI:1174873236
Name:RYAN, ERIN DEBAILLON (RD, LDN)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:DEBAILLON
Last Name:RYAN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:ELIZABETH
Other - Last Name:DEBAILLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:1111 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE S-450
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3151
Mailing Address - Country:US
Mailing Address - Phone:504-349-6423
Mailing Address - Fax:504-349-6062
Practice Address - Street 1:1111 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE S-450
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3151
Practice Address - Country:US
Practice Address - Phone:504-349-6401
Practice Address - Fax:504-349-6062
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2051133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2313355Medicaid
LA248312YH9WMedicare PIN