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NPI Code Detail

MEDICARE: MAGGIE LEFAVOR

MEDICARE: MAGGIE LEFAVOR
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 Dietitian

General Provider Information

NPI Number : 1417472861
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAGGIE LEFAVOR
Provider Business Mailing Address
First Line : 15000 MIDLANTIC DR STE 101
Second Line :
City : MOUNT LAUREL
State : NJ
Zip : 08054-1573
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2551 N CLARK ST STE 400
Second Line :
City : CHICAGO
State : IL
Zip : 60614-7725
Country : US
Telephone Number : 312-533-1754
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2017
Last Update Date : 06/20/2024

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