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NPI Code Detail

MEDICARE: MRS. SANDRA LYNN DREYER RD

MEDICARE: MRS. SANDRA LYNN DREYER 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
1133V00000XRegistered Dietitian2001007916MO

General Provider Information

NPI Number : 1255054334
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SANDRA LYNN DREYER RD
Provider Business Mailing Address
First Line : 707 JEFFERSON STREET
Second Line :
City : FULTON
State : MO
Zip : 65251
Country : US
Telephone Number : 660-216-7247
Fax Number :
Provider Business Practice Location Address
First Line : 600 E 5TH ST
Second Line :
City : FULTON
State : MO
Zip : 65251-1793
Country : US
Telephone Number : 572-592-4100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2022
Last Update Date : 09/22/2022

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