Provider Demographics
NPI:1760675276
Name:PEIFFER, MARY ELIZABETH (RD, LD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:PEIFFER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 BLAIRS FERRY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-1949
Mailing Address - Country:US
Mailing Address - Phone:319-369-9690
Mailing Address - Fax:319-294-5809
Practice Address - Street 1:1350 BLAIRS FERRY RD
Practice Address - Street 2:SUITE C
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-1949
Practice Address - Country:US
Practice Address - Phone:319-369-9690
Practice Address - Fax:319-294-5809
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00440133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI5617Medicare PIN