Provider Demographics
NPI:1922834068
Name:MANLEY, DEMI MARIE (RD)
Entity type:Individual
Prefix:
First Name:DEMI
Middle Name:MARIE
Last Name:MANLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:DEMI
Other - Middle Name:MARIE
Other - Last Name:STAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3210 WESTENEDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-1626
Mailing Address - Country:US
Mailing Address - Phone:812-344-2080
Mailing Address - Fax:
Practice Address - Street 1:3210 WESTENEDGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-1626
Practice Address - Country:US
Practice Address - Phone:812-344-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered