Provider Demographics
NPI:1063966935
Name:FRANCIS, SHIRLEY (RD/LD)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:FRANCIS
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 OLD BORAX RD
Mailing Address - Street 2:PO BOX 216
Mailing Address - City:SPILLVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52168-4421
Mailing Address - Country:US
Mailing Address - Phone:563-562-3497
Mailing Address - Fax:
Practice Address - Street 1:201 OLD BORAX RD
Practice Address - Street 2:
Practice Address - City:SPILLVILLE
Practice Address - State:IA
Practice Address - Zip Code:52168-4421
Practice Address - Country:US
Practice Address - Phone:563-562-3497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00553133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered