Provider Demographics
NPI:1285838037
Name:ALDRICH, NANCY MARIE (MSRDLD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:MARIE
Last Name:ALDRICH
Suffix:
Gender:F
Credentials:MSRDLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17651 B HWY
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-2839
Mailing Address - Country:US
Mailing Address - Phone:660-882-7461
Mailing Address - Fax:660-882-6093
Practice Address - Street 1:17651 B HWY
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-2839
Practice Address - Country:US
Practice Address - Phone:660-882-7461
Practice Address - Fax:660-882-6093
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005013078133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
260004Medicare ID - Type Unspecified
MO267240Medicare ID - Type UnspecifiedHOME HEALTH