Individual
SHANNON WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
2409 RIO MESA DR, AUSTIN, TX 78732-1964
(415) 260-8995
Mailing address
2409 RIO MESA DRIVE, AUSTIN, TX 78732
(415) 260-8995
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT81117
TX
Other
Enumeration date
11/23/2016
Last updated
11/23/2016
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