Provider Demographics
NPI:1205014610
Name:STUCKWISCH, MARJORIE L (RD)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:L
Last Name:STUCKWISCH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:L
Other - Last Name:OAKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 500202
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-0202
Mailing Address - Country:US
Mailing Address - Phone:512-250-9140
Mailing Address - Fax:
Practice Address - Street 1:6500 N MOPAC
Practice Address - Street 2:BLDG III,STE 220
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3282
Practice Address - Country:US
Practice Address - Phone:512-338-4500
Practice Address - Fax:512-338-4501
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2015-029133V00000X
TXDT82069133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DF186OtherBCBS OF TEXAS
966937OtherRD NUMBER