NPI 1053687426 · live from the CMS NPI Registry
Shirley W Anderson, RDLD
Dietitian, Registered in Fenton, MO. National Provider Identifier 1053687426, active.
NPI record
| NPI | 1053687426 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 1015 Bowles Ave, Fenton, MO 63026 |
| Practice phone | 636-496-5815 |
| Mailing address | 410 Wilcox Ave, Kirkwood, MO 63122 |
| Enumerated | March 29, 2012 |
| Last updated | March 29, 2012 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | 20040226599 (MO) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.