Provider Demographics
NPI:1609236207
Name:SHULTICE, TESSA (RD, LMNT)
Entity Type:Individual
Prefix:MISS
First Name:TESSA
Middle Name:
Last Name:SHULTICE
Suffix:
Gender:F
Credentials:RD, LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 GORDON DR.
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105
Mailing Address - Country:US
Mailing Address - Phone:515-480-4316
Mailing Address - Fax:
Practice Address - Street 1:3301 GORDON DR
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105-3708
Practice Address - Country:US
Practice Address - Phone:515-480-4316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1191133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered