MEDICARE: MS. LORA PIETSZAK 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	841846

General Provider Information

NPI Number	:	1952535619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORA PIETSZAK R.D.

Provider Business Mailing Address
First Line	:	31 AMDS/SGPZ
Second Line	:	UNIT 6180 BOX 245
City	:	APO
State	:	AE
Zip	:	09601-0245
Country	:	US
Telephone Number	:	43-430-4573
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 AMDS/SGPZ
Second Line	:	UNIT 6180 BOX 245
City	:	APO
State	:	AE
Zip	:	09601-0245
Country	:	US
Telephone Number	:	43-430-4573
Fax Number	:

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

Provider Enumeration Date	:	05/11/2009
Last Update Date	:	05/11/2009

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