Provider Demographics
NPI:1871719195
Name:MARLETTE-BORAS, JACQUELINE IRENE (RD, LDN)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:IRENE
Last Name:MARLETTE-BORAS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8920 STEPHENS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723
Mailing Address - Country:US
Mailing Address - Phone:410-997-7778
Mailing Address - Fax:410-997-7669
Practice Address - Street 1:8920 STEPHENS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723
Practice Address - Country:US
Practice Address - Phone:410-997-7778
Practice Address - Fax:410-997-7669
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00521133NN1002X
MDD00531133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered