Provider Demographics
NPI:1285617811
Name:DERR, BARBARA WISHART (RD, LD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:WISHART
Last Name:DERR
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 1:140 ELIZABETH WAY
Mailing Address - Street 2:
Mailing Address - City:BETHANY BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19930-9167
Mailing Address - Country:US
Mailing Address - Phone:302-537-1309
Mailing Address - Fax:
Practice Address - Street 1:9733 HEALTHWAY DR
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1155
Practice Address - Country:US
Practice Address - Phone:410-641-9773
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2456133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered