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NPI Code Detail

MEDICARE: MRS. TERESA GEHRT SANBORN RD, LD

MEDICARE: MRS. TERESA GEHRT SANBORN 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
1133V00000XRegistered Dietitian583KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558363440
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TERESA GEHRT SANBORN RD, LD
Provider Business Mailing Address
First Line : 1823 COLLEGE AVE.
Second Line :
City : MANHATTAN
State : KS
Zip : 66502-3381
Country : US
Telephone Number : 785-776-3322
Fax Number : 785-587-5447
Provider Business Practice Location Address
First Line : 1105 SUNSET AVE.
Second Line :
City : MANHATTAN
State : KS
Zip : 66502-3381
Country : US
Telephone Number : 785-776-3322
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 08/11/2010

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