MEDICARE: KATELYN ENGEL 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	133N00000X	Nutritionist	0414	SD
2	133V00000X	Registered Dietitian	01069099

General Provider Information

NPI Number	:	1841565041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN ENGEL RD

Provider Business Mailing Address
First Line	:	4201 W VALHALLA BLVD APT 26
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-5232
Country	:	US
Telephone Number	:	612-743-2340
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 W VALHALLA BLVD APT 26
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-5232
Country	:	US
Telephone Number	:	612-743-2340
Fax Number	:

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

Provider Enumeration Date	:	03/20/2012
Last Update Date	:	03/20/2012

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Directions to “ KATELYN ENGEL RD” Practice Location

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