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General NPI Number Information
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NPI Number | 1205876091
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Entity Type | Individual
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Provider Name | JOYCE ANN MAUEL RD, CDE.
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Gender | Female
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4801 VETERANS DR
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City | SAINT CLOUD
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State | MN
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Zip | 56303-2015
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Country | US
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Telephone | 320-255-6376
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Fax |
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Provider Business Mailing Address
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Address Line | 2513 SERENITY DR
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City | SAINT CLOUD
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State | MN
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Zip | 56301-9177
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Country | US
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Telephone | 320-255-6480
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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 | 00885409
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License Number State | MN
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