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NPI Code Detail

MEDICARE: MRS. MARY H STAUDTER MS, RD, LD

MEDICARE: MRS. MARY H STAUDTER MS, RD, LD
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
1133V00000XRegistered Dietitian2009001936MO

General Provider Information

NPI Number : 1386975068
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY H STAUDTER MS, RD, LD
Provider Business Mailing Address
First Line : 126 MISSOURI AVE
Second Line : BOX 1252
City : FORT LEONARD WOOD
State : MO
Zip : 65473-8952
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 126 MISSOURI AVE
Second Line : BOX 1252
City : FORT LEONARD WOOD
State : MO
Zip : 65473-8952
Country : US
Telephone Number : 573-596-1762
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2010
Last Update Date : 01/20/2010

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