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NPI Code Detail

MEDICARE: CANDACE JAYNE BIRD RD

MEDICARE: CANDACE JAYNE BIRD 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 DietitianL1594OH

General Provider Information

NPI Number : 1780695544
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDACE JAYNE BIRD RD
Provider Business Mailing Address
First Line : 55 W WATERLOO RD
Second Line :
City : AKRON
State : OH
Zip : 44319-1116
Country : US
Telephone Number : 330-724-7715
Fax Number : 330-724-1029
Provider Business Practice Location Address
First Line : 55 W WATERLOO RD
Second Line :
City : AKRON
State : OH
Zip : 44319-1116
Country : US
Telephone Number : 330-724-7715
Fax Number : 330-724-1029
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2006
Last Update Date : 07/08/2007

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Directions to “ CANDACE JAYNE BIRD RD” Practice Location

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