MEDICARE: MRS. LIZA H DREW R.D., L.D.

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	0632	NH

General Provider Information

NPI Number	:	1427319284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LIZA H DREW R.D., L.D.

Provider Business Mailing Address
First Line	:	127 TAYLOR POND RD
Second Line	:
City	:	SULLIVAN
State	:	NH
Zip	:	03445-4420
Country	:	US
Telephone Number	:	603-831-0688
Fax Number	:	888-626-3687

Provider Business Practice Location Address
First Line	:	127 TAYLOR POND RD
Second Line	:
City	:	SULLIVAN
State	:	NH
Zip	:	03445-4420
Country	:	US
Telephone Number	:	603-831-0688
Fax Number	:	888-626-3687

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

Provider Enumeration Date	:	06/07/2012
Last Update Date	:	06/07/2012

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