Doctor Name: | JADE N. MANCZUK |
NPI Number: | 1124377395 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RD, LD |
License Number: | 2012024502 |
Business Practice Address: | 3231 S. National Suite 430 Springfield, MO - 65807 |
Business Phone Number: | 4178885660 |
Business Fax Number: | 4178886793 |
Mailing Address: | P.o. Box 504274, ST. LOUIS |
State: | MO |
Postal Code: | 631504274 |
Phone Number: | 4178202000 |
Fax Number: | |
NPI Enumeration Date: | 09/04/2012 |
NPI Last Update Date: | 09/04/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | 2012024502 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | |
Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |