MEDICARE: JANET MACON MS, RD, LD

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	133V00000X	Registered Dietitian	3175	MN

General Provider Information

NPI Number	:	1396149936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET MACON MS, RD, LD

Provider Business Mailing Address
First Line	:	222 INTEGRATED WELLNESS COMPLEX
Second Line	:	P.O. BOX 5838
City	:	WINONA
State	:	MN
Zip	:	55987-5838
Country	:	US
Telephone Number	:	507-457-5160
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 INTEGRATED WELLNESS COMPLEX
Second Line	:	175 WEST MARK STREET
City	:	WINONA
State	:	MN
Zip	:	55987-5838
Country	:	US
Telephone Number	:	507-457-5160
Fax Number	:

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

Provider Enumeration Date	:	10/10/2014
Last Update Date	:	10/10/2014

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