Provider Demographics
NPI:1891163218
Name:WEINER, STEFANIE (RD)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:WEINER
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 1:919 CLOISTER RD
Mailing Address - Street 2:APT E
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-1018
Mailing Address - Country:US
Mailing Address - Phone:302-494-5979
Mailing Address - Fax:
Practice Address - Street 1:919 CLOISTER RD
Practice Address - Street 2:APT E
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-1018
Practice Address - Country:US
Practice Address - Phone:302-494-5979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005705133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered