MEDICARE: DR. MARY J MARIAN D.C.N., R.D.N.

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	13526	IL

General Provider Information

NPI Number	:	1467818443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY J MARIAN D.C.N., R.D.N.

Provider Business Mailing Address
First Line	:	6310 N CANON DEL PAJARO
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-1366
Country	:	US
Telephone Number	:	520-299-2957
Fax Number	:

Provider Business Practice Location Address
First Line	:	6310 N CANON DEL PAJARO
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-1366
Country	:	US
Telephone Number	:	520-299-2957
Fax Number	:

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

Provider Enumeration Date	:	01/06/2016
Last Update Date	:	01/06/2016

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