NPI 1144598889 · live from the CMS NPI Registry
Shannon Medenwald, RD
Dietitian, Registered in Brookings, SD. National Provider Identifier 1144598889, active.
NPI record
| NPI | 1144598889 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 300 22nd Ave, Brookings, SD 57006 |
| Practice phone | 605-696-9000 |
| Mailing address | 4415 Calico Dr S, Apt 303, Fargo, ND 58104 |
| Enumerated | December 8, 2011 |
| Last updated | December 8, 2011 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | 0419 (SD) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.