Provider Demographics
NPI:1942044896
Name:TRAMMELL, MARISA (RD, LD)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:TRAMMELL
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 GRASS LICK RUN
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:WV
Mailing Address - Zip Code:26283-7146
Mailing Address - Country:US
Mailing Address - Phone:304-704-7574
Mailing Address - Fax:
Practice Address - Street 1:530 GRASS LICK RUN
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:WV
Practice Address - Zip Code:26283-7146
Practice Address - Country:US
Practice Address - Phone:304-704-7574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered