MEDICARE: LAURA MARIE NANCE RD, CDE

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

General Provider Information

NPI Number	:	1881608420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MARIE NANCE RD, CDE

Provider Business Mailing Address
First Line	:	552 FORT JOHNSON RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-9174
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 ASHLEY AVE
Second Line	:	BOX 250905
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8905
Country	:	US
Telephone Number	:	843-876-0479
Fax Number	:

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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