MEDICARE: FAYE MB MOSELEY RDN CD CDCES

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	747	WI

General Provider Information

NPI Number	:	1326042813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAYE MB MOSELEY RDN CD CDCES

Provider Business Mailing Address
First Line	:	1836 SOUTH AVE
Second Line	:
City	:	LA CROSSE
State	:	WI
Zip	:	54601-5429
Country	:	US
Telephone Number	:	608-782-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 E VETERANS ST
Second Line	:
City	:	TOMAH
State	:	WI
Zip	:	54660-3105
Country	:	US
Telephone Number	:	608-372-3971
Fax Number	:

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	08/31/2021

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