Provider Demographics
NPI:1871748749
Name:TWELLMAN, SALLY JANE (RD,LD)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:JANE
Last Name:TWELLMAN
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 HOFFMAN CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4126
Mailing Address - Country:US
Mailing Address - Phone:512-699-3910
Mailing Address - Fax:
Practice Address - Street 1:2003 HOFFMAN CT
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4126
Practice Address - Country:US
Practice Address - Phone:512-901-2821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07309133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered