Basic Information
| Provider Information | |||||||||
| NPI: | 1104317379 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCENANEY | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | J | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 N 12TH ST | ||||||||
| Address2: | |||||||||
| City: | TARKIO | ||||||||
| State: | MO | ||||||||
| PostalCode: | 644911411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6606239128 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 PERSHING AVE | ||||||||
| Address2: | |||||||||
| City: | SHENANDOAH | ||||||||
| State: | IA | ||||||||
| PostalCode: | 516012355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122467400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2018 | ||||||||
| LastUpdateDate: | 05/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 2018000658 | MO | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | 091770 | IA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.