Provider Demographics
NPI:1457656308
Name:CHESNEY, SHIRLEY MARIE (RD LN)
Entity Type:Individual
Prefix:MISS
First Name:SHIRLEY
Middle Name:MARIE
Last Name:CHESNEY
Suffix:
Gender:F
Credentials:RD LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 4TH ST. SE
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350
Mailing Address - Country:US
Mailing Address - Phone:605-353-6200
Mailing Address - Fax:605-353-6504
Practice Address - Street 1:172 4TH ST. SE
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-2510
Practice Address - Country:US
Practice Address - Phone:605-353-6200
Practice Address - Fax:605-353-6504
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0042133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered