MEDICARE: REBECCA A DRISCOLL RD

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	1983	MN

General Provider Information

NPI Number	:	1154364602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA A DRISCOLL RD

Provider Business Mailing Address
First Line	:	1670 ROBERT ST S # 129
Second Line	:
City	:	WEST ST PAUL
State	:	MN
Zip	:	55118-3918
Country	:	US
Telephone Number	:	651-276-8018
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 DORSET RD
Second Line	:
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55118-1914
Country	:	US
Telephone Number	:	651-276-8018
Fax Number	:

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	05/20/2011

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