MEDICARE: HAYLEY E DAUBERT RD, LDN

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	DN001397	PA

General Provider Information

NPI Number	:	1114259736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAYLEY E DAUBERT RD, LDN

Provider Business Mailing Address
First Line	:	2041 FIELDVIEW DR
Second Line	:
City	:	NAZARETH
State	:	PA
Zip	:	18064-8407
Country	:	US
Telephone Number	:	610-360-0486
Fax Number	:	610-365-8587

Provider Business Practice Location Address
First Line	:	6083 HAMILTON BLVD
Second Line	:
City	:	WESCOSVILLE
State	:	PA
Zip	:	18106-9767
Country	:	US
Telephone Number	:	610-360-0486
Fax Number	:	610-365-8587

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

Provider Enumeration Date	:	02/06/2010
Last Update Date	:	02/06/2010

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