MEDICARE: MS. NANCY ANN BENNETT MS, 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	133VN1006X	Metabolic Nutrition Registered Dietitian

General Provider Information

NPI Number	:	1396874798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY ANN BENNETT MS, RD, CDE

Provider Business Mailing Address
First Line	:	7548 ODYSSEY WAY
Second Line	:
City	:	DUBLIN
State	:	CA
Zip	:	94568-1811
Country	:	US
Telephone Number	:	510-303-9822
Fax Number	:

Provider Business Practice Location Address
First Line	:	2475 WASHINGTON ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-1816
Country	:	US
Telephone Number	:	415-346-1475
Fax Number	:	925-833-1154

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

Provider Enumeration Date	:	03/04/2007
Last Update Date	:	07/08/2007

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