MEDICARE: MARY TADLOCK MIELKE ND

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	175F00000X	Naturopath	NP-0077	DC

General Provider Information

NPI Number	:	1346704376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY TADLOCK MIELKE ND

Provider Business Mailing Address
First Line	:	9211 FOREST HILL AVE STE 204
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-6877
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9211 FOREST HILL AVE STE 204
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-6877
Country	:	US
Telephone Number	:	804-977-2634
Fax Number	:

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

Provider Enumeration Date	:	01/23/2019
Last Update Date	:	01/23/2019

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