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NPI Code Detail

MEDICARE: MRS. RAE JEAN VERSAGLI REGISTERED DIETICIAN

MEDICARE: MRS. RAE JEAN VERSAGLI REGISTERED DIETICIAN
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 Dietitian504065DE

General Provider Information

NPI Number : 1144393976
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. RAE JEAN VERSAGLI REGISTERED DIETICIAN
Provider Business Mailing Address
First Line : 726 LOVEVILLE RD
Second Line :
City : HOCKESSIN
State : DE
Zip : 19707-1515
Country : US
Telephone Number : 302-235-6074
Fax Number : 302-235-6001
Provider Business Practice Location Address
First Line : 726 LOVEVILLE RD
Second Line :
City : HOCKESSIN
State : DE
Zip : 19707-1515
Country : US
Telephone Number : 302-235-6074
Fax Number : 302-235-6001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2006
Last Update Date : 07/08/2007

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