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NPI Code Detail

MEDICARE: MACIA NOORMAN RD

MEDICARE: MACIA NOORMAN 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
1133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1063025153
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACIA NOORMAN RD
Provider Business Mailing Address
First Line : 3639 HYDRAULIC AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63116-4624
Country : US
Telephone Number : 616-520-5765
Fax Number :
Provider Business Practice Location Address
First Line : 3639 HYDRAULIC AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63116-4624
Country : US
Telephone Number : 616-520-5765
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2020
Last Update Date : 09/13/2024

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Directions to “ MACIA NOORMAN RD” Practice Location

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