Provider Demographics
NPI:1477183630
Name:SAVAGE, STACIE (MS RDN LDN)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:MS RDN LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22618 KRISTIN DR
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:MO
Mailing Address - Zip Code:64844-7370
Mailing Address - Country:US
Mailing Address - Phone:719-271-2586
Mailing Address - Fax:
Practice Address - Street 1:22618 KRISTIN DR
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:MO
Practice Address - Zip Code:64844-7370
Practice Address - Country:US
Practice Address - Phone:719-271-2586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered