MEDICARE: DEBRA B SHEATS MPH RD LD

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	1324	MN

General Provider Information

NPI Number	:	1457677387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA B SHEATS MPH RD LD

Provider Business Mailing Address
First Line	:	1356 SARGENT AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-2327
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1356 SARGENT AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-2327
Country	:	US
Telephone Number	:	651-213-4286
Fax Number	:

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

Provider Enumeration Date	:	04/16/2010
Last Update Date	:	04/16/2010

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