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General NPI Number Information
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NPI Number | 1205463080
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Entity Type | Individual
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Provider Name | TANA MCCOY RD
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Gender | Female
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 03/24/2020
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Provider Practice Location Address
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Address Line | 1 MEDICAL CENTER DR
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City | LEBANON
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State | NH
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Zip | 03756-0001
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Country | US
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Telephone | 603-650-5000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 511
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City | WILDER
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State | VT
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Zip | 05088-0511
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Country | US
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Telephone | 802-356-5971
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86050787
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License Number State | VT
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