MEDICARE: MS. NINA FEARON RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	133N00000X	Nutritionist
2	133VN1005X	Renal Nutrition Registered Dietitian
3	133VN1006X	Metabolic Nutrition Registered Dietitian
4	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1376848515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NINA FEARON RDN

Provider Business Mailing Address
First Line	:	6642 S LAKE SHORE DR
Second Line	:
City	:	HARBOR SPRINGS
State	:	MI
Zip	:	49740-9785
Country	:	US
Telephone Number	:	231-881-6497
Fax Number	:

Provider Business Practice Location Address
First Line	:	8482 M 119 STE 18A
Second Line	:
City	:	HARBOR SPRINGS
State	:	MI
Zip	:	49740-9595
Country	:	US
Telephone Number	:	231-881-6497
Fax Number	:

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

Provider Enumeration Date	:	01/19/2011
Last Update Date	:	02/08/2019

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