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NPI Code Detail

MEDICARE: MISS TESSA SHULTICE RD, LMNT

MEDICARE: MISS TESSA SHULTICE RD, LMNT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian1191NE

General Provider Information

NPI Number : 1609236207
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS TESSA SHULTICE RD, LMNT
Provider Business Mailing Address
First Line : 3301 GORDON DR.
Second Line :
City : SIOUX CITY
State : IA
Zip : 51105
Country : US
Telephone Number : 515-480-4316
Fax Number :
Provider Business Practice Location Address
First Line : 3301 GORDON DR
Second Line :
City : SIOUX CITY
State : IA
Zip : 51105-3708
Country : US
Telephone Number : 515-480-4316
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2016
Last Update Date : 01/30/2017

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Directions to “ MISS TESSA SHULTICE RD, LMNT” Practice Location

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