Provider Demographics
NPI:1043870173
Name:HIEBERT, MARY A (RDN, LD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:HIEBERT
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 N MAIZE CT APT 1906
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4396
Mailing Address - Country:US
Mailing Address - Phone:316-616-4937
Mailing Address - Fax:
Practice Address - Street 1:271 W 3RD ST N STE 500
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-1223
Practice Address - Country:US
Practice Address - Phone:316-660-5141
Practice Address - Fax:316-660-1936
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0660133NN1002X, 133V00000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174H00000XOther Service ProvidersHealth Educator