Individual
MARGARET JANE MALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD LN BC-ADM CDE
Contact information
Practice address
1323 BIA ROUTE 4, FORT THOMPSON, SD 57339-0200
(604) 245-1534
Mailing address
PO BOX 200, 1323 BIA ROUTE 4, FORT THOMPSON, SD 57339-0200
(604) 245-1534
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
425
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000K3526
—
NM
01
—
HSZ196
MEDICARE PART B
NM
Enumeration date
09/22/2006
Last updated
06/05/2015
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