Individual
SHANNON MEDENWALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
300 22ND AVE, BROOKINGS, SD 57006-2480
(605) 696-9000
Mailing address
4415 CALICO DR S, APT 303, FARGO, ND 58104-8744
(701) 200-7233
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
0419
SD
Other
Enumeration date
12/08/2011
Last updated
12/08/2011
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