Provider Demographics
NPI:1356773089
Name:SCHULTE, ALEXIS L (RD)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:L
Last Name:SCHULTE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:L
Other - Last Name:HERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9302 MEDICAL PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9142
Mailing Address - Country:US
Mailing Address - Phone:874-847-5093
Mailing Address - Fax:
Practice Address - Street 1:9302 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9142
Practice Address - Country:US
Practice Address - Phone:843-847-5093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164006010133V00000X
SC1556133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
F400099545Medicare PIN