Provider Demographics
NPI:1114392719
Name:RANSHAW, MADELEINE (RD, LD)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:RANSHAW
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 1:2200 W KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-5369
Mailing Address - Country:US
Mailing Address - Phone:563-391-0213
Mailing Address - Fax:563-391-9117
Practice Address - Street 1:2200 W KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5369
Practice Address - Country:US
Practice Address - Phone:563-391-0213
Practice Address - Fax:563-391-9117
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080229133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered