Provider Demographics
NPI:1811930035
Name:STAUDER, MARIE T (RN, LAPN, CDE)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:T
Last Name:STAUDER
Suffix:
Gender:F
Credentials:RN, LAPN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 W WEAVER RD
Mailing Address - Street 2:SUITE 210 DMH WELLNESS CENTER
Mailing Address - City:FORSYTH
Mailing Address - State:IL
Mailing Address - Zip Code:62535-9799
Mailing Address - Country:US
Mailing Address - Phone:217-876-5366
Mailing Address - Fax:217-876-5375
Practice Address - Street 1:2300 N EDWARD ST
Practice Address - Street 2:DECATUR MEMORIAL HOSPITAL
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4163
Practice Address - Country:US
Practice Address - Phone:217-876-8121
Practice Address - Fax:217-876-2261
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered