Provider Demographics
NPI:1316778319
Name:IRWIN, LEAH (RDN, LD)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:IRWIN
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1666 BRIARCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135-9531
Mailing Address - Country:US
Mailing Address - Phone:415-238-2021
Mailing Address - Fax:
Practice Address - Street 1:1666 BRIARCLIFF DR
Practice Address - Street 2:
Practice Address - City:NOLENSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37135-9531
Practice Address - Country:US
Practice Address - Phone:415-238-2021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000004699133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered