NPI 1053805382 · live from the CMS NPI Registry
Sheridan Peak Wellness
Dietitian, Registered in Sheridan, WY. National Provider Identifier 1053805382, active.
NPI record
| NPI | 1053805382 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 740 S. Thurmond St., Sheridan, WY 82801 |
| Practice phone | 307-683-6874 |
| Enumerated | June 20, 2018 |
| Last updated | June 20, 2018 |
| Authorized official | Jennifer Clark, Corporation Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nutritionist, Nutrition, Education | 133NN1002X | — |
| Dietitian, Registered, Nutrition, Pediatric | 133VN1004X | — |
| Dietitian, Registered, Nutrition, Metabolic | 133VN1006X | — |
| Dietitian, Registered primary | 133V00000X | 232 (WY) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.