Basic Information
| Provider Information | |||||||||
| NPI: | 1508173907 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHIFFERDECKER | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DIETICIAN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MUETH | ||||||||
| OtherFirstName: | MICHELE | ||||||||
| OtherMiddleName: | C | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1836 LACKLAND HILL PKWY | ||||||||
| Address2: | ATTN CREDENTIALING DEPARTMENT | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631463572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148721308 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5900 BOND AVE | ||||||||
| Address2: | |||||||||
| City: | CENTREVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622072326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183325212 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2010 | ||||||||
| LastUpdateDate: | 09/07/2010 | ||||||||
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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 | 164002761 | IL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.