Provider Demographics
NPI:1124042072
Name:THURAU, ALICE LOUISE (MS, RD)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:LOUISE
Last Name:THURAU
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11484 E REIDSBURG RD
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-4446
Mailing Address - Country:US
Mailing Address - Phone:814-764-5215
Mailing Address - Fax:
Practice Address - Street 1:825 E MAIN ST
Practice Address - Street 2:RENAL CARE OF CLARION
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-1124
Practice Address - Country:US
Practice Address - Phone:814-223-4655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002192133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered