Healthcare Provider Details

I. General information

NPI: 1053762971
Provider Name (Legal Business Name): MARSHA FLOWERS MHS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL FOOD AND NUTRITION- LS-15
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

1 CHILDRENS PL FOOD AND NUTRITION- LS-15
SAINT LOUIS MO
63110-1002
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-4249
  • Fax: 314-454-2557
Mailing address:
  • Phone: 314-454-4249
  • Fax: 314-454-2557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number2002026980
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: