MEDICARE: DIABETES MANAGEMENT CONSULTANTS LLC

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	824138	NM

General Provider Information

NPI Number	:	1073791851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETES MANAGEMENT CONSULTANTS LLC

Provider Business Mailing Address
First Line	:	9976 WILDE WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5537
Country	:	US
Telephone Number	:	702-267-7752
Fax Number	:

Provider Business Practice Location Address
First Line	:	9976 WILDE WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5537
Country	:	US
Telephone Number	:	702-267-7752
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. HEATHER LEIGH LAMAR
Credential	:	RD CDE
Telephone Number	:	702-267-7752

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	02/04/2008

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