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NPI Code Detail

MEDICARE: MS. CONSTANCE F METCALF RD

MEDICARE: MS. CONSTANCE F METCALF 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 Dietitian

General Provider Information

NPI Number : 1295925873
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CONSTANCE F METCALF RD
Provider Business Mailing Address
First Line : 1105 6TH ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-2345
Country : US
Telephone Number : 231-935-8217
Fax Number : 231-935-8215
Provider Business Practice Location Address
First Line : 1105 6TH ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-2386
Country : US
Telephone Number : 231-935-8217
Fax Number : 231-935-8215
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2007
Last Update Date : 07/30/2007

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