Provider Demographics
NPI:1952444051
Name:THADEN, JUANITA COLLEEN
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:COLLEEN
Last Name:THADEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N 7TH AVE
Mailing Address - Street 2:P.O. BOX 250
Mailing Address - City:SHELDON
Mailing Address - State:IA
Mailing Address - Zip Code:51201-1235
Mailing Address - Country:US
Mailing Address - Phone:712-324-5041
Mailing Address - Fax:712-324-6025
Practice Address - Street 1:118 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:IA
Practice Address - Zip Code:51201-1235
Practice Address - Country:US
Practice Address - Phone:712-324-5041
Practice Address - Fax:712-324-6025
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00508133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered