Provider Demographics
NPI:1588069413
Name:WEBER, DAWN THERESA (RD, LD)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:THERESA
Last Name:WEBER
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 1:9431 ENGEL LN
Mailing Address - Street 2:
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3417
Mailing Address - Country:US
Mailing Address - Phone:314-496-4205
Mailing Address - Fax:
Practice Address - Street 1:9431 ENGEL LN
Practice Address - Street 2:
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-3417
Practice Address - Country:US
Practice Address - Phone:314-496-4205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011012529133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200668739Medicaid