MEDICARE: SHANNON GIESE 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	2024	KS

General Provider Information

NPI Number	:	1205544616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON GIESE RD

Provider Business Mailing Address
First Line	:	11104 N MADISON AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-1331
Country	:	US
Telephone Number	:	816-590-2209
Fax Number	:

Provider Business Practice Location Address
First Line	:	11104 N MADISON AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-1331
Country	:	US
Telephone Number	:	816-590-2209
Fax Number	:

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

Provider Enumeration Date	:	11/14/2022
Last Update Date	:	11/14/2022

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Directions to “ SHANNON GIESE RD” Practice Location

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