Provider Demographics
NPI:1124207907
Name:MEANS, MARY MALVINA (RD LD MA)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:MALVINA
Last Name:MEANS
Suffix:
Gender:F
Credentials:RD LD MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 MESKWAKI RD
Mailing Address - Street 2:
Mailing Address - City:TAMA
Mailing Address - State:IA
Mailing Address - Zip Code:52339-9634
Mailing Address - Country:US
Mailing Address - Phone:641-484-4094
Mailing Address - Fax:
Practice Address - Street 1:307 MESKWAKI RD
Practice Address - Street 2:
Practice Address - City:TAMA
Practice Address - State:IA
Practice Address - Zip Code:52339-9634
Practice Address - Country:US
Practice Address - Phone:641-484-4094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01415133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered