Provider Demographics
NPI:1770241093
Name:STEPHANIE VARLEY RDN LD NUTRITION CONSULTANT
Entity Type:Organization
Organization Name:STEPHANIE VARLEY RDN LD NUTRITION CONSULTANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD
Authorized Official - Phone:651-408-5312
Mailing Address - Street 1:3762 BIG FOX RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4130
Mailing Address - Country:US
Mailing Address - Phone:651-408-5312
Mailing Address - Fax:
Practice Address - Street 1:3762 BIG FOX RD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55110-4130
Practice Address - Country:US
Practice Address - Phone:651-408-5312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-03
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty