MEDICARE: GERI LYNN GROSSAN

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

General Provider Information

NPI Number	:	1437270584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERI LYNN GROSSAN

Provider Business Mailing Address
First Line	:	7721 LEAVORITE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-4094
Country	:	US
Telephone Number	:	702-242-5730
Fax Number	:	702-242-1417

Provider Business Practice Location Address
First Line	:	7721 LEAVORITE DRIVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128
Country	:	US
Telephone Number	:	702-242-5730
Fax Number	:	702-242-1417

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

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

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Directions to “ GERI LYNN GROSSAN ” Practice Location

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