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NPI Code Detail

MEDICARE: MRS. MIRANDA A LOWERY RD

MEDICARE:  MRS. MIRANDA A LOWERY  RD
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
1133V00000XRegistered Dietitian1719TN

General Provider Information

NPI Number : 1528267556
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MIRANDA A LOWERY RD
Provider Business Mailing Address
First Line : 1801 N JACKSON ST
Second Line :
City : TULLAHOMA
State : TN
Zip : 37388-8259
Country : US
Telephone Number : 931-393-3000
Fax Number : 931-461-4684
Provider Business Practice Location Address
First Line : 1801 N JACKSON ST
Second Line :
City : TULLAHOMA
State : TN
Zip : 37388-8259
Country : US
Telephone Number : 931-393-3000
Fax Number : 931-461-4684
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2007
Last Update Date : 07/11/2007

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Directions to “ MRS. MIRANDA A LOWERY RD” Practice Location

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