MEDICARE: MS. JEANNE M BRADFORD MS RD

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	579902

General Provider Information

NPI Number	:	1033164082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEANNE M BRADFORD MS RD

Provider Business Mailing Address
First Line	:	6968 OAKLEIGH DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110
Country	:	US
Telephone Number	:	702-452-5687
Fax Number	:	702-452-5687

Provider Business Practice Location Address
First Line	:	6968 OAKLEIGH DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110
Country	:	US
Telephone Number	:	702-452-5687
Fax Number	:	702-452-5687

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	12/30/2008

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