Provider Demographics
NPI:1841612611
Name:STUHR, MARY TERESA (RD, LD, LMNT, CDE)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:TERESA
Last Name:STUHR
Suffix:
Gender:F
Credentials:RD, LD, LMNT, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 WOODRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-8425
Mailing Address - Country:US
Mailing Address - Phone:402-740-3423
Mailing Address - Fax:
Practice Address - Street 1:2910 S 84TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3213
Practice Address - Country:US
Practice Address - Phone:402-399-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1124133V00000X
IA706133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered