MEDICARE: MARY A DUNAWAY RD, CDE

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	32133-DI-4	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396788048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY A DUNAWAY RD, CDE

Provider Business Mailing Address
First Line	:	2121 E FLAMINGO RD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5123
Country	:	US
Telephone Number	:	702-382-8841
Fax Number	:	702-369-2370

Provider Business Practice Location Address
First Line	:	2121 E FLAMINGO RD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5123
Country	:	US
Telephone Number	:	702-382-8841
Fax Number	:	702-369-2370

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	10/05/2021

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