Basic Information
| Provider Information | |||||||||
| NPI: | 1033261342 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JANECEK | ||||||||
| FirstName: | LEAH | ||||||||
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| Credential: | R.D, L.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5207 FM 533 | ||||||||
| Address2: | |||||||||
| City: | SHINER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779845375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3915943199 | ||||||||
| FaxNumber: | 3615943486 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 CARL RAMERT DR | ||||||||
| Address2: | |||||||||
| City: | YOAKUM | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779954868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3612932321 | ||||||||
| FaxNumber: | 3612937055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DT03984 | TX | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.