Provider Demographics
NPI:1427676501
Name:DIRRIM, MOLLY (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:DIRRIM
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 ST RD 67 N
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-7848
Mailing Address - Country:US
Mailing Address - Phone:765-346-2106
Mailing Address - Fax:
Practice Address - Street 1:3401 N MORRISON RD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5568
Practice Address - Country:US
Practice Address - Phone:765-284-6822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37003186A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty