MEDICARE: MRS. DENISE LISE MADORE RD, CSP, CNSC

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	133N00000X	Nutritionist	871573	VA
2	133V00000X	Registered Dietitian

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	:	1396955654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENISE LISE MADORE RD, CSP, CNSC

Provider Business Mailing Address
First Line	:	2 COLAWICKI DR
Second Line	:
City	:	NORTH YARMOUTH
State	:	ME
Zip	:	04097-6752
Country	:	US
Telephone Number	:	804-433-5682
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 COLAWICKI DR
Second Line	:
City	:	NORTH YARMOUTH
State	:	ME
Zip	:	04097-6752
Country	:	US
Telephone Number	:	804-433-5682
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	06/17/2011

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