MEDICARE: MARY ELISE KLOPFENSTEIN RD, LD, CDE

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
1	133V00000X	Registered Dietitian	01731	IA

General Provider Information

NPI Number	:	1770714362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELISE KLOPFENSTEIN RD, LD, CDE

Provider Business Mailing Address
First Line	:	407 S WHITE ST
Second Line	:
City	:	MOUNT PLEASANT
State	:	IA
Zip	:	52641-2263
Country	:	US
Telephone Number	:	319-385-6143
Fax Number	:	319-385-6571

Provider Business Practice Location Address
First Line	:	407 S WHITE ST
Second Line	:
City	:	MOUNT PLEASANT
State	:	IA
Zip	:	52641-2263
Country	:	US
Telephone Number	:	319-385-6143
Fax Number	:	319-385-6571

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2009
Last Update Date	:	07/31/2009

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