MEDICARE: MRS. CAROLYN STORTZ R.D.L.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	2000172498	MO

General Provider Information

NPI Number	:	1275771511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLYN STORTZ R.D.L.D.

Provider Business Mailing Address
First Line	:	2840 ERB RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-4523
Country	:	US
Telephone Number	:	314-846-2898
Fax Number	:

Provider Business Practice Location Address
First Line	:	2840 ERB RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-4523
Country	:	US
Telephone Number	:	314-846-2898
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2009
Last Update Date	:	01/24/2009

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