MEDICARE: HANNAH STAPLES 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
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1548735335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH STAPLES RD

Provider Business Mailing Address
First Line	:	2044 GLENDALE BLVD
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49004-1715
Country	:	US
Telephone Number	:	616-826-0226
Fax Number	:

Provider Business Practice Location Address
First Line	:	2044 GLENDALE BLVD
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49004-1715
Country	:	US
Telephone Number	:	616-826-0226
Fax Number	:

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

Provider Enumeration Date	:	10/08/2018
Last Update Date	:	10/08/2018

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Directions to “ HANNAH STAPLES RD” Practice Location

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