MEDICARE: KIRSTEN WONN RD/LDN

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	ND 3203	FL

General Provider Information

NPI Number	:	1629180724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN WONN RD/LDN

Provider Business Mailing Address
First Line	:	1022 SE 14TH DR
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-7231
Country	:	US
Telephone Number	:	954-249-4086
Fax Number	:

Provider Business Practice Location Address
First Line	:	780 SW 24TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-2643
Country	:	US
Telephone Number	:	954-762-3651
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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