MEDICARE: RAMONA RAE DACHROEDEN CDE

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	163WD0400X	Diabetes Educator Registered Nurse	085982	MO

General Provider Information

NPI Number	:	1174150312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMONA RAE DACHROEDEN CDE

Provider Business Mailing Address
First Line	:	1701 E BROADWAY STE 102
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-8029
Country	:	US
Telephone Number	:	573-815-3870
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 E BROADWAY STE 102
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-8029
Country	:	US
Telephone Number	:	573-815-3870
Fax Number	:

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

Provider Enumeration Date	:	03/26/2020
Last Update Date	:	03/26/2020

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