MEDICARE: MEGAN JANE NOONAN-CONLON 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	133V00000X	Registered Dietitian	002085	IA

General Provider Information

NPI Number	:	1538506084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN JANE NOONAN-CONLON RD, LD

Provider Business Mailing Address
First Line	:	611 5TH AVE N
Second Line	:
City	:	HUMBOLDT
State	:	IA
Zip	:	50548-1420
Country	:	US
Telephone Number	:	515-368-2233
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 4TH ST SW
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-4664
Country	:	US
Telephone Number	:	641-424-2605
Fax Number	:

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

Provider Enumeration Date	:	05/23/2013
Last Update Date	:	05/23/2013

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