Individual
MS. MARCIA ANN WIRTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DIETICIAN
Contact information
Practice address
600 N COLLEGE AVE, GENESEO, IL 61254-1091
(309) 944-6431
Mailing address
600 N COLLEGE AVE, GENESEO, IL 61254-1091
(309) 944-6431
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
716443
IL
Other
Enumeration date
12/06/2006
Last updated
07/08/2007
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