MEDICARE: MRS. KAREN CHINN BAIN R.D.

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

General Provider Information

NPI Number	:	1255683272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAREN CHINN BAIN R.D.

Provider Business Mailing Address
First Line	:	1625 E PRATER WAY STE 102
Second Line	:
City	:	SPARKS
State	:	NV
Zip	:	89434-8963
Country	:	US
Telephone Number	:	775-352-6680
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 E PRATER WAY STE 102
Second Line	:
City	:	SPARKS
State	:	NV
Zip	:	89434-8963
Country	:	US
Telephone Number	:	775-352-6680
Fax Number	:

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

Provider Enumeration Date	:	10/15/2012
Last Update Date	:	10/15/2012

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