Provider Demographics
NPI:1427279751
Name:CLAUNCH, MARILYN G (RD LD)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:G
Last Name:CLAUNCH
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:PO BOX 970
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-0970
Mailing Address - Country:US
Mailing Address - Phone:256-332-7310
Mailing Address - Fax:256-331-0927
Practice Address - Street 1:68 MARCO DR SE
Practice Address - Street 2:PRICEVILLE FAMILY MEDICINE SOUTHERN RURAL HEALTH CARE
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-0000
Practice Address - Country:US
Practice Address - Phone:256-432-2007
Practice Address - Fax:256-432-2010
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL612554133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered