Provider Demographics
NPI:1205014610
Name:STUCKWISCH, MARJORIE L (RD)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:L
Last Name:STUCKWISCH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:L
Other - Last Name:OAKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:3805A SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1600
Mailing Address - Country:US
Mailing Address - Phone:262-687-4011
Mailing Address - Fax:
Practice Address - Street 1:3805A SPRING ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53405-1600
Practice Address - Country:US
Practice Address - Phone:262-687-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82069133V00000X
WI2015-029133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
966937OtherRD NUMBER
TX8DF186OtherBCBS OF TEXAS