Provider Demographics
NPI:1770714362
Name:KLOPFENSTEIN, MARY ELISE (RD, LD, CDE)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELISE
Last Name:KLOPFENSTEIN
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELISE
Other - Last Name:HAZELWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD, CDE
Mailing Address - Street 1:407 S WHITE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-2263
Mailing Address - Country:US
Mailing Address - Phone:319-385-6143
Mailing Address - Fax:319-385-6571
Practice Address - Street 1:407 S WHITE ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-2263
Practice Address - Country:US
Practice Address - Phone:319-385-6143
Practice Address - Fax:319-385-6571
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01731133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered