Provider Demographics
NPI:1437521077
Name:SHAFFER, MARCI (RD)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 WINDWARD WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2618
Mailing Address - Country:US
Mailing Address - Phone:406-758-7888
Mailing Address - Fax:406-758-7898
Practice Address - Street 1:430 WINDWARD WAY STE 101
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2618
Practice Address - Country:US
Practice Address - Phone:406-758-7888
Practice Address - Fax:406-758-7898
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-NUTR-LIC-388133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered