| Doctor Name: | MS. SHANNON K MOORE |
| NPI Number: | 1346522539 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RD, CD |
| License Number: | 1058178 |
| Business Practice Address: | 1050 Division St Mauston, WI - 539481931 |
| Business Phone Number: | 6088471295 |
| Business Fax Number: | |
| Mailing Address: | 135 Grand Canyon Dr, Ap 107 A BARABOO |
| State: | WI |
| Postal Code: | 539139077 |
| Phone Number: | 7632420778 |
| Fax Number: | |
| NPI Enumeration Date: | 09/13/2011 |
| NPI Last Update Date: | 09/13/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 1058178 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| 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 |