MEDICARE: MS. MCKENZIE NICOLE RAMIREZ

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	DT85543	TX

General Provider Information

NPI Number	:	1609411990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MCKENZIE NICOLE RAMIREZ

Provider Business Mailing Address
First Line	:	700 E PARK BLVD STE 110
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-8842
Country	:	US
Telephone Number	:	972-422-9180
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 E PARK BLVD STE 110
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-8842
Country	:	US
Telephone Number	:	972-422-9180
Fax Number	:

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

Provider Enumeration Date	:	11/11/2019
Last Update Date	:	11/11/2019

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