Provider Demographics
NPI:1346404514
Name:MOBERLY, DANENE JANA (MPH, RD, LD, CDE)
Entity type:Individual
Prefix:MRS
First Name:DANENE
Middle Name:JANA
Last Name:MOBERLY
Suffix:
Gender:F
Credentials:MPH, RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21212 NORTHWEST FWY
Mailing Address - Street 2:STE 405
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5887
Mailing Address - Country:US
Mailing Address - Phone:832-237-3500
Mailing Address - Fax:
Practice Address - Street 1:2495 S BRAESWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4332
Practice Address - Country:US
Practice Address - Phone:832-237-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83686133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered