Provider Demographics
NPI:1336901586
Name:HARTZELL, SHERRIE LOUISE
Entity Type:Individual
Prefix:
First Name:SHERRIE
Middle Name:LOUISE
Last Name:HARTZELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHERRIE
Other - Middle Name:LOUISE
Other - Last Name:HARTZELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN/LD
Mailing Address - Street 1:1532 W 32ND ST STE 202
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1627
Mailing Address - Country:US
Mailing Address - Phone:417-347-5700
Mailing Address - Fax:417-347-5635
Practice Address - Street 1:1532 W 32ND ST STE 202
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1627
Practice Address - Country:US
Practice Address - Phone:417-347-5700
Practice Address - Fax:417-347-5635
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK698133V00000X
MO2023050434133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered