Individual
JADE N. MANCZUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
3231 S. NATIONAL, SUITE 430, SPRINGFIELD, MO 65807
(417) 888-5660
(417) 888-6793
Mailing address
P.O. BOX 504274, ST. LOUIS, MO 63150-4274
(417) 820-2000
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2012024502
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
440552485
TRICARE
MO
Enumeration date
09/04/2012
Last updated
09/04/2012
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