Provider Demographics
NPI:1134982945
Name:SIMMEL, MADELINE (RDN)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:SIMMEL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 S 6TH ST W APT B
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3679
Mailing Address - Country:US
Mailing Address - Phone:406-531-4877
Mailing Address - Fax:
Practice Address - Street 1:2130 S 6TH ST W APT B
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3679
Practice Address - Country:US
Practice Address - Phone:406-531-4877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-NUTR-LIC-77995133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered