Provider Demographics
NPI:1528507969
Name:DIMMEY, MARY ROSE (RD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ROSE
Last Name:DIMMEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BALSAM DR
Mailing Address - Street 2:
Mailing Address - City:TRIADELPHIA
Mailing Address - State:WV
Mailing Address - Zip Code:26059-9618
Mailing Address - Country:US
Mailing Address - Phone:304-365-7647
Mailing Address - Fax:
Practice Address - Street 1:67670 TRACO DR
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-9375
Practice Address - Country:US
Practice Address - Phone:304-365-7647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV908133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered