MEDICARE: MS. KRISTI MASON RD, 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 5063	OH

General Provider Information

NPI Number	:	1104097955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTI MASON RD, LD

Provider Business Mailing Address
First Line	:	3355 GLENDALE AVE FL 3
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2426
Country	:	US
Telephone Number	:	419-383-6272
Fax Number	:	419-383-3112

Provider Business Practice Location Address
First Line	:	1125 HOSPITAL DR.
Second Line	:	HEALTH SCIENCE CAMPUS MAIL STOP 1062
City	:	TOLEDO
State	:	OH
Zip	:	43614-2598
Country	:	US
Telephone Number	:	419-383-4585
Fax Number	:	419-383-3112

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

Provider Enumeration Date	:	03/20/2008
Last Update Date	:	12/22/2017

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