Provider Demographics
NPI:1780845743
Name:MCCALL, MARILYN SUKKE (RD, LD)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:SUKKE
Last Name:MCCALL
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BROADWAY PL
Mailing Address - Street 2:
Mailing Address - City:ANAMOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52205-1100
Mailing Address - Country:US
Mailing Address - Phone:319-462-6135
Mailing Address - Fax:
Practice Address - Street 1:104 BROADWAY PL
Practice Address - Street 2:
Practice Address - City:ANAMOSA
Practice Address - State:IA
Practice Address - Zip Code:52205-1100
Practice Address - Country:US
Practice Address - Phone:319-462-6135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00692133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered