Provider Demographics
NPI:1366225476
Name:COVA, ISABELLA MARIE (MS, RDN, LD)
Entity type:Individual
Prefix:MS
First Name:ISABELLA
Middle Name:MARIE
Last Name:COVA
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 LENARD CT
Mailing Address - Street 2:
Mailing Address - City:AFFTON
Mailing Address - State:MO
Mailing Address - Zip Code:63123-4435
Mailing Address - Country:US
Mailing Address - Phone:314-445-8993
Mailing Address - Fax:
Practice Address - Street 1:1905 CHERRY HILL DR STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5812
Practice Address - Country:US
Practice Address - Phone:573-343-4017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164007916133V00000X
KS2593133V00000X
NE1599133V00000X
MO2018024311133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered