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NPI Code Detail

MEDICARE: MRS. TERRA LYNN DAVIDSON RDLD

MEDICARE: MRS. TERRA LYNN DAVIDSON RDLD
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 Dietitian1273KS

General Provider Information

NPI Number : 1386646198
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TERRA LYNN DAVIDSON RDLD
Provider Business Mailing Address
First Line : 1804 BROWNING AVE
Second Line :
City : MANHATTAN
State : KS
Zip : 66502-2302
Country : US
Telephone Number : 785-476-5430
Fax Number :
Provider Business Practice Location Address
First Line : 1823 COLLEGE AVE
Second Line :
City : MANHATTAN
State : KS
Zip : 66502-3381
Country : US
Telephone Number : 785-776-2886
Fax Number : 785-565-4742
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 07/08/2007

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