MEDICARE: JARED HILL DAHLE 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	133V00000X	Registered Dietitian	912883

General Provider Information

NPI Number	:	1871671149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED HILL DAHLE RD

Provider Business Mailing Address
First Line	:	KADENA HEALTH & WELLNESS CENTER
Second Line	:	18 AMDS/SGPZ
City	:	APO
State	:	AP
Zip	:	96368-5267
Country	:	US
Telephone Number	:	315-634-0180
Fax Number	:

Provider Business Practice Location Address
First Line	:	KADENA HEALTH & WELLNESS CENTER
Second Line	:	18 AMDS/SGPZ
City	:	APO
State	:	AP
Zip	:	96368-5267
Country	:	US
Telephone Number	:	315-634-0180
Fax Number	:

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/16/2009

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