Provider Demographics
NPI:1982432654
Name:HERBERT, MAYCI ANASTASIA (RDN, LRD)
Entity type:Individual
Prefix:
First Name:MAYCI
Middle Name:ANASTASIA
Last Name:HERBERT
Suffix:
Gender:F
Credentials:RDN, LRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 BOSSIER RD
Mailing Address - Street 2:
Mailing Address - City:BARKSDALE AFB
Mailing Address - State:LA
Mailing Address - Zip Code:71110-2040
Mailing Address - Country:US
Mailing Address - Phone:916-347-2115
Mailing Address - Fax:
Practice Address - Street 1:224 BOSSIER RD
Practice Address - Street 2:
Practice Address - City:BARKSDALE AFB
Practice Address - State:LA
Practice Address - Zip Code:71110-2040
Practice Address - Country:US
Practice Address - Phone:916-347-2115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3824133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty