MEDICARE: JOCIE MINTURN RD, LMNT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1079	NE

General Provider Information

NPI Number	:	1043645005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOCIE MINTURN RD, LMNT

Provider Business Mailing Address
First Line	:	5115 F ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68117-2807
Country	:	US
Telephone Number	:	402-333-0898
Fax Number	:	402-397-1404

Provider Business Practice Location Address
First Line	:	8715 OAK ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-3051
Country	:	US
Telephone Number	:	402-333-0898
Fax Number	:	402-397-1404

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2013
Last Update Date	:	09/10/2013

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