MEDICARE: MRS. KIMBERLY MARIE MARRE M.S., L.D., R.D.

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	2001023557	MO

General Provider Information

NPI Number	:	1790059822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY MARIE MARRE M.S., L.D., R.D.

Provider Business Mailing Address
First Line	:	6400 CLAYTON RD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117-1850
Country	:	US
Telephone Number	:	314-768-8891
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 CLAYTON RD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117-1850
Country	:	US
Telephone Number	:	314-768-8891
Fax Number	:

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

Provider Enumeration Date	:	03/07/2012
Last Update Date	:	03/07/2012

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