Provider Demographics
NPI:1285137562
Name:FENTON, MARCY NAN (MS, RDN)
Entity type:Individual
Prefix:
First Name:MARCY
Middle Name:NAN
Last Name:FENTON
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:MARCY
Other - Middle Name:NAN FENTON
Other - Last Name:BORNEMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8022 OSAGE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3336
Mailing Address - Country:US
Mailing Address - Phone:310-428-1898
Mailing Address - Fax:
Practice Address - Street 1:8022 OSAGE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3336
Practice Address - Country:US
Practice Address - Phone:310-428-1898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered