Provider Demographics
NPI:1396757068
Name:BAIN, DEEYA MARY HAGEN (RD)
Entity type:Individual
Prefix:MRS
First Name:DEEYA
Middle Name:MARY HAGEN
Last Name:BAIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
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Mailing Address - Street 1:5301 BELLO VISTA DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-9285
Mailing Address - Country:US
Mailing Address - Phone:903-267-4868
Mailing Address - Fax:903-583-6692
Practice Address - Street 1:1201 E 9TH ST
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4059
Practice Address - Country:US
Practice Address - Phone:903-583-1334
Practice Address - Fax:903-583-6449
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
658274133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered