MEDICARE: MRS. AUDRA MAE SCHWEIM 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

General Provider Information

NPI Number	:	1972529766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AUDRA MAE SCHWEIM R.D.

Provider Business Mailing Address
First Line	:	1627 NORTHRIDGE LN
Second Line	:
City	:	NORTH MANKATO
State	:	MN
Zip	:	56003-1632
Country	:	US
Telephone Number	:	507-388-5597
Fax Number	:

Provider Business Practice Location Address
First Line	:	1627 NORTHRIDGE LN
Second Line	:
City	:	NORTH MANKATO
State	:	MN
Zip	:	56003-1632
Country	:	US
Telephone Number	:	507-388-5597
Fax Number	:

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/08/2007

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