MEDICARE: MS. MARLENE DIXIE KRAMER RD

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	ND77	FL
2	133V00000X	Registered Dietitian	436647	FL

General Provider Information

NPI Number	:	1467601179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARLENE DIXIE KRAMER RD

Provider Business Mailing Address
First Line	:	214 S PINE AVE
Second Line	:
City	:	INVERNESS
State	:	FL
Zip	:	34452-4838
Country	:	US
Telephone Number	:	407-467-8463
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 S PINE AVE
Second Line	:
City	:	INVERNESS
State	:	FL
Zip	:	34452-4838
Country	:	US
Telephone Number	:	407-467-8463
Fax Number	:

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

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	06/03/2014

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