MEDICARE: MS. CHRISTINA HOLDEN GANZON R.D.

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

General Provider Information

NPI Number	:	1558551093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINA HOLDEN GANZON R.D.

Provider Business Mailing Address
First Line	:	3245 LAKE RD
Second Line	:
City	:	SENECA FALLS
State	:	NY
Zip	:	13148-9416
Country	:	US
Telephone Number	:	315-568-0093
Fax Number	:

Provider Business Practice Location Address
First Line	:	3245 LAKE RD
Second Line	:
City	:	SENECA FALLS
State	:	NY
Zip	:	13148-9416
Country	:	US
Telephone Number	:	315-568-0093
Fax Number	:

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

Provider Enumeration Date	:	07/31/2007
Last Update Date	:	07/31/2007

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