Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 1744 | NE |
NPI | 1386987162 |
---|---|
Provider Name | Trenton Leroy Talbitzer |
First Address | Kearney, NE 68847-8110 |
Second Address | Kearney, NE 68847-8110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2013 |
Last Update Date | 25/02/2014 |