Provider Demographics
NPI:1629672878
Name:LABENZ, STEPHANIE A (RDN, LD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:LABENZ
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6836 NW 87TH CT
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-4745
Mailing Address - Country:US
Mailing Address - Phone:515-321-1624
Mailing Address - Fax:
Practice Address - Street 1:6836 NW 87TH CT
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-4745
Practice Address - Country:US
Practice Address - Phone:515-321-1624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered