Provider Demographics
NPI:1528055282
Name:GUILD, DEBORAH L (RD LD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:GUILD
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:A
Other - Last Name:LIDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LD
Mailing Address - Street 1:404 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1257
Mailing Address - Country:US
Mailing Address - Phone:641-621-2651
Mailing Address - Fax:
Practice Address - Street 1:404 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1257
Practice Address - Country:US
Practice Address - Phone:641-621-2651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01524133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q08947Medicare UPIN
IAI11342Medicare PIN
IA560910051Medicare PIN