MEDICARE: MRS. WAHNETA M HAYWOOD 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	00150	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00150	OTHER	IA	LICENSE, DIETETICS
2	401087	OTHER		REGISTERED DIETITIAN

General Provider Information

NPI Number	:	1447521067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WAHNETA M HAYWOOD R.D., L.D

Provider Business Mailing Address
First Line	:	2722 BADGER AVE
Second Line	:
City	:	JANESVILLE
State	:	IA
Zip	:	50647-9774
Country	:	US
Telephone Number	:	319-987-2345
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 9TH ST SW
Second Line	:
City	:	WAVERLY
State	:	IA
Zip	:	50677-2929
Country	:	US
Telephone Number	:	319-352-4120
Fax Number	:

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

Provider Enumeration Date	:	01/13/2012
Last Update Date	:	01/13/2012

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