Provider Demographics
NPI:1780865303
Name:ORTMEIER, STACIE R (RD, LMNT)
Entity Type:Individual
Prefix:MS
First Name:STACIE
Middle Name:R
Last Name:ORTMEIER
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 1:430 NORTH MONITOR STREET
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:NE
Mailing Address - Zip Code:68788-1595
Mailing Address - Country:US
Mailing Address - Phone:402-372-2404
Mailing Address - Fax:402-372-2360
Practice Address - Street 1:430 NORTH MONITOR STREET
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NE
Practice Address - Zip Code:68788-1595
Practice Address - Country:US
Practice Address - Phone:402-372-2404
Practice Address - Fax:402-372-2360
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE721133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist