MEDICARE: SAMANTHA LOUIE RDN

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	133NN1002X	Nutrition Education Nutritionist

General Provider Information

NPI Number	:	1487201596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA LOUIE RDN

Provider Business Mailing Address
First Line	:	14320 POTOMAC HEIGHTS LN
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-3844
Country	:	US
Telephone Number	:	415-810-2189
Fax Number	:

Provider Business Practice Location Address
First Line	:	14320 POTOMAC HEIGHTS LN
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-3844
Country	:	US
Telephone Number	:	415-810-2189
Fax Number	:

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

Provider Enumeration Date	:	08/22/2019
Last Update Date	:	08/22/2019

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