Healthcare Provider Details

I. General information

NPI: 1477712925
Provider Name (Legal Business Name): LOU KUPKA-SCHUTT PHD, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 E KINCAID ST
MOUNT VERNON WA
98274-4126
US

IV. Provider business mailing address

PO BOX 1376
MOUNT VERNON WA
98273-1376
US

V. Phone/Fax

Practice location:
  • Phone: 306-424-4111
  • Fax:
Mailing address:
  • Phone: 360-424-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI00000022
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: