Provider Demographics
NPI:1295895191
Name:DUTCHER, MARY E (CDE)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:DUTCHER
Suffix:
Gender:F
Credentials:CDE
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:ELDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1215 PLEASANT ST STE 300
Mailing Address - Street 2:BLANK CHILDREN'S HEALTH CENTER II
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1416
Mailing Address - Country:US
Mailing Address - Phone:515-241-6500
Mailing Address - Fax:515-241-8911
Practice Address - Street 1:1215 PLEASANT ST STE 300
Practice Address - Street 2:BLANK CHILDREN'S HEALTH CENTER II
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1416
Practice Address - Country:US
Practice Address - Phone:515-241-6500
Practice Address - Fax:515-241-8911
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00116133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric