MEDICARE: PATRICIA CORAPI HARRIS RD, LD

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	133VN1005X	Renal Nutrition Registered Dietitian	016	AL

General Provider Information

NPI Number	:	1134124225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA CORAPI HARRIS RD, LD

Provider Business Mailing Address
First Line	:	3735 WOODHILL RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109-1354
Country	:	US
Telephone Number	:	334-322-4448
Fax Number	:	334-277-5082

Provider Business Practice Location Address
First Line	:	3735 WOODHILL RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109-1354
Country	:	US
Telephone Number	:	334-322-4448
Fax Number	:	334-277-5082

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	10/06/2010

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