MEDICARE: MARINA DANIELLE CHANNER RDN

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	86071860	NE

General Provider Information

NPI Number	:	1669098166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINA DANIELLE CHANNER RDN

Provider Business Mailing Address
First Line	:	3159 43RD AVE
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-4421
Country	:	US
Telephone Number	:	402-910-9207
Fax Number	:

Provider Business Practice Location Address
First Line	:	3159 43RD AVE
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-4421
Country	:	US
Telephone Number	:	402-910-9207
Fax Number	:

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

Provider Enumeration Date	:	06/19/2020
Last Update Date	:	06/19/2020

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