MEDICARE: CARRIE JOAN PEITZMEIER L.I.S.W, R.D., L.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	00000	IA
2	1041C0700X	Clinical Social Worker	04198	IA

General Provider Information

NPI Number	:	1275535890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE JOAN PEITZMEIER L.I.S.W, R.D., L.D.

Provider Business Mailing Address
First Line	:	3900 INGERSOLL AVE
Second Line	:	SUITE 201
City	:	DES MOINES
State	:	IA
Zip	:	50312-3534
Country	:	US
Telephone Number	:	515-255-2224
Fax Number	:	515-255-2228

Provider Business Practice Location Address
First Line	:	3900 INGERSOLL AVE
Second Line	:	SUITE 201
City	:	DES MOINES
State	:	IA
Zip	:	50312-3534
Country	:	US
Telephone Number	:	515-255-2224
Fax Number	:	515-255-2228

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	08/14/2013

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