Provider Demographics
NPI:1811125172
Name:SHIPE TUSLER, VICKY JO (RD LN)
Entity type:Individual
Prefix:MS
First Name:VICKY
Middle Name:JO
Last Name:SHIPE TUSLER
Suffix:
Gender:F
Credentials:RD LN
Other - Prefix:MS
Other - First Name:VICKY
Other - Middle Name:JO
Other - Last Name:SHIPE TUSLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDLN
Mailing Address - Street 1:PO BOX 636
Mailing Address - Street 2:352 ASH CREEK ROAD
Mailing Address - City:TERRY
Mailing Address - State:MT
Mailing Address - Zip Code:59349-0636
Mailing Address - Country:US
Mailing Address - Phone:406-486-5641
Mailing Address - Fax:
Practice Address - Street 1:2200 BOX ELDER ST
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-2899
Practice Address - Country:US
Practice Address - Phone:406-234-6034
Practice Address - Fax:406-234-7018
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT465133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist