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NPI Code Detail

MEDICARE: MS. VICKY JO SHIPE TUSLER R.D. L.N.

MEDICARE:  MS. VICKY JO SHIPE TUSLER  R.D. L.N.
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
1133N00000XNutritionist465MT
2133V00000XRegistered Dietitian465MT

General Provider Information

NPI Number : 1811125172
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. VICKY JO SHIPE TUSLER R.D. L.N.
Provider Business Mailing Address
First Line : PO BOX 636
Second Line : 352 ASH CREEK ROAD
City : TERRY
State : MT
Zip : 59349-0636
Country : US
Telephone Number : 406-486-5641
Fax Number :
Provider Business Practice Location Address
First Line : 2200 BOX ELDER ST
Second Line :
City : MILES CITY
State : MT
Zip : 59301-2899
Country : US
Telephone Number : 406-234-6034
Fax Number : 406-234-7018
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2009
Last Update Date : 06/25/2009

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