MEDICARE: DEANNA D KAY RD CD

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	1732	WI

General Provider Information

NPI Number	:	1477661403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA D KAY RD CD

Provider Business Mailing Address
First Line	:	825 WHITING AVE
Second Line	:
City	:	STEVENS POINT
State	:	WI
Zip	:	54481-5246
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 WHITING AVE
Second Line	:
City	:	STEVENS POINT
State	:	WI
Zip	:	54481-5246
Country	:	US
Telephone Number	:	715-346-1374
Fax Number	:

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	01/13/2009

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