Provider Demographics
NPI:1740595370
Name:PANTHERA, MARSHA C (RD)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:C
Last Name:PANTHERA
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 1:7421 HIDDEN VALLEY HOLW S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-5734
Mailing Address - Country:US
Mailing Address - Phone:651-458-1916
Mailing Address - Fax:
Practice Address - Street 1:3000 HUNDERTMARK RD
Practice Address - Street 2:SUITE 2
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1150
Practice Address - Country:US
Practice Address - Phone:952-361-0042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2299133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered