MEDICARE: DAWN NOE LD

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	LD-5800	OH

General Provider Information

NPI Number	:	1104012111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN NOE LD

Provider Business Mailing Address
First Line	:	10685 CARNEGIE AVE
Second Line	:	X20
City	:	CLEVELAND
State	:	OH
Zip	:	44106-3018
Country	:	US
Telephone Number	:	216-445-8928
Fax Number	:	216-444-3474

Provider Business Practice Location Address
First Line	:	10685 CARNEGIE AVE
Second Line	:	X20
City	:	CLEVELAND
State	:	OH
Zip	:	44106-3018
Country	:	US
Telephone Number	:	216-445-8928
Fax Number	:	216-444-3474

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

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	10/15/2012

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