Provider Demographics
NPI:1811613649
Name:MACHACEK, STEPHANIE (MS, CNS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MACHACEK
Suffix:
Gender:F
Credentials:MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 PALMDALE CT
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-6149
Mailing Address - Country:US
Mailing Address - Phone:651-246-4856
Mailing Address - Fax:
Practice Address - Street 1:912 PALMDALE CT
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-6149
Practice Address - Country:US
Practice Address - Phone:651-246-4856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education