Provider Demographics
NPI:1053093229
Name:STANOVICH, YVONNE RACHELLE (MS, RD LD)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:RACHELLE
Last Name:STANOVICH
Suffix:
Gender:F
Credentials:MS, RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:06754 DEEP CUT RD
Mailing Address - Street 2:
Mailing Address - City:SPENCERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45887-9374
Mailing Address - Country:US
Mailing Address - Phone:269-332-3427
Mailing Address - Fax:
Practice Address - Street 1:06754 DEEP CUT RD
Practice Address - Street 2:
Practice Address - City:SPENCERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45887-9374
Practice Address - Country:US
Practice Address - Phone:269-332-3427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.09604133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered