Healthcare Provider Details

I. General information

NPI: 1356856819
Provider Name (Legal Business Name): JOELEEN MARIE STOCKER MS, RD, CSP, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E PARK AVE NUTRITION & CULINARY SERVICES
STATE COLLEGE PA
16803
US

IV. Provider business mailing address

1800 E PARK AVE NUTRITION & CULINARY SERVICES
STATE COLLEGE PA
16803
US

V. Phone/Fax

Practice location:
  • Phone: 814-231-7091
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number925236
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: