Provider Demographics
NPI:1487908638
Name:HAUCK, MICHELLE LYNN (MS, RD, LD, LMNT, LN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:HAUCK
Suffix:
Gender:F
Credentials:MS, RD, LD, LMNT, LN
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:2720 STONE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3734
Mailing Address - Country:US
Mailing Address - Phone:712-279-1813
Mailing Address - Fax:712-279-1854
Practice Address - Street 1:2720 STONE PARK BLVD
Practice Address - Street 2:NFS DEPT.
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3734
Practice Address - Country:US
Practice Address - Phone:712-279-1813
Practice Address - Fax:712-279-1854
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01202133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered