Provider Demographics
NPI:1073705489
Name:STEINBROCK, MARY G (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:G
Last Name:STEINBROCK
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 S ROCK RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-5150
Mailing Address - Country:US
Mailing Address - Phone:316-682-7411
Mailing Address - Fax:316-689-6688
Practice Address - Street 1:1709 S ROCK RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5150
Practice Address - Country:US
Practice Address - Phone:316-682-7411
Practice Address - Fax:316-689-6688
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS000352133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSQ18651Medicare UPIN