Provider Demographics
NPI:1427447044
Name:MARCIA KRISITIN SCHULTZ
Entity type:Organization
Organization Name:MARCIA KRISITIN SCHULTZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPH RD LDN
Authorized Official - Phone:815-739-1040
Mailing Address - Street 1:1289 ARMOUR RD
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2105
Mailing Address - Country:US
Mailing Address - Phone:815-739-1040
Mailing Address - Fax:
Practice Address - Street 1:1289 ARMOUR RD
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2105
Practice Address - Country:US
Practice Address - Phone:815-739-1040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005534133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty