MEDICARE: LINDA GLANZMANN

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	ND2165	FL

General Provider Information

NPI Number	:	1255365425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA GLANZMANN

Provider Business Mailing Address
First Line	:	3920 N HIGHWAY A1A APT 201
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34949-8547
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1060 6TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5922
Country	:	US
Telephone Number	:	772-913-2842
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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