| NPI | 1689049488 |
|---|---|
| Former Name | MARISSA BANE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133VN1004X Dietitian, Registered, Nutrition, Pediatric (Licence: FL ND7485) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: FL ND7485) |
| Enumeration Date | 2015-12-04 |
| Last Update Date | 2025-07-28 |