Individual
MS. CORISSA SUE SPACKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNS, LDN, NBC-HWC
Contact information
Practice address
32 N GOULD ST STE R, SHERIDAN, WY 82801-6317
(307) 343-3680
Mailing address
32 N GOULD ST STE R, SHERIDAN, WY 82801-6317
(307) 314-4467
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
DX6913
MD
133N00000X
Nutritionist
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
171400000X
Health & Wellness Coach
—
—
Other
Enumeration date
10/23/2023
Last updated
11/01/2024
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