Healthcare Provider Details

I. General information

NPI: 1962220608
Provider Name (Legal Business Name): LAREINE SCHOCK RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7215 NORMANDY DR
FORT RILEY KS
66442
US

IV. Provider business mailing address

2275 BUCKINGHAM ST APT 3
MANHATTAN KS
66503-2118
US

V. Phone/Fax

Practice location:
  • Phone: 619-677-0517
  • Fax:
Mailing address:
  • Phone: 316-209-1323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number2878
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: