MEDICARE: NAN E CRINER RN, BSN, CDE

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	133NN1002X	Nutrition Education Nutritionist	RN.205132	OH

General Provider Information

NPI Number	:	1295869105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAN E CRINER RN, BSN, CDE

Provider Business Mailing Address
First Line	:	4825 KNIGHTSBRIDGE BLVD
Second Line	:	SUITE A
City	:	COLUMBUS
State	:	OH
Zip	:	43214-2352
Country	:	US
Telephone Number	:	614-459-0216
Fax Number	:	614-459-0362

Provider Business Practice Location Address
First Line	:	4825 KNIGHTSBRIDGE BLVD
Second Line	:	SUITE A
City	:	COLUMBUS
State	:	OH
Zip	:	43214-2352
Country	:	US
Telephone Number	:	614-459-0216
Fax Number	:	614-459-0362

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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