Healthcare Provider Details

I. General information

NPI: 1295895191
Provider Name (Legal Business Name): MARY E DUTCHER CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY E ELDER

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 PLEASANT ST STE 300 BLANK CHILDREN'S HEALTH CENTER II
DES MOINES IA
50309-1416
US

IV. Provider business mailing address

1215 PLEASANT ST STE 300 BLANK CHILDREN'S HEALTH CENTER II
DES MOINES IA
50309-1416
US

V. Phone/Fax

Practice location:
  • Phone: 515-241-6500
  • Fax: 515-241-8911
Mailing address:
  • Phone: 515-241-6500
  • Fax: 515-241-8911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number00116
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: