| Doctor Name: | MRS. SHANNON M WIEDERHOLT |
| NPI Number: | 1972647287 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RD,LDN,CDE |
| License Number: | 1075 |
| Business Practice Address: | 408 N State Of Franklin Rd Suite#31 Johnson City, TN - 376046089 |
| Business Phone Number: | 4234618880 |
| Business Fax Number: | 4234618887 |
| Mailing Address: | 408 N State Of Franklin Rd, Suite#31 JOHNSON CITY |
| State: | TN |
| Postal Code: | 376046089 |
| Phone Number: | 4234618880 |
| Fax Number: | 4234618887 |
| NPI Enumeration Date: | 02/19/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 1075 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| 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 |