MEDICARE: RITA DUNCAN

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	L005017	NC
2	133V00000X	Registered Dietitian	9435	FL

General Provider Information

NPI Number	:	1053860858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RITA DUNCAN

Provider Business Mailing Address
First Line	:	16540 HERON COACH WAY APT 405
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-5523
Country	:	US
Telephone Number	:	239-910-6980
Fax Number	:

Provider Business Practice Location Address
First Line	:	16540 HERON COACH WAY APT 405
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-5523
Country	:	US
Telephone Number	:	239-910-6980
Fax Number	:

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

Provider Enumeration Date	:	09/22/2016
Last Update Date	:	02/08/2020

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