MEDICARE: JUDE TRAUTLEIN 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	133VN1004X	Pediatric Nutrition Registered Dietitian

General Provider Information

NPI Number	:	1528281300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDE TRAUTLEIN RD

Provider Business Mailing Address
First Line	:	2509 N CAMPBELL AVE
Second Line	:	#122
City	:	TUCSON
State	:	AZ
Zip	:	85719-3304
Country	:	US
Telephone Number	:	520-235-0307
Fax Number	:

Provider Business Practice Location Address
First Line	:	2764 N WARREN AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-3142
Country	:	US
Telephone Number	:	520-235-0307
Fax Number	:

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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Directions to “ JUDE TRAUTLEIN RD” Practice Location

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