MEDICARE: MRS. JOANNA ELAINE TOWNSEND RD, CDE

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	916154	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	916154	OTHER	TX	COMMISSION ON DIETETIC REGISTRATION
2	2052-0444	OTHER	TX	NATIONAL CERTIFICATION BOARD FOR DIABETES EDUCATORS

General Provider Information

NPI Number	:	1669692000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOANNA ELAINE TOWNSEND RD, CDE

Provider Business Mailing Address
First Line	:	2875 W RAY RD
Second Line	:	SUITE 16
City	:	CHANDLER
State	:	AZ
Zip	:	85224-3524
Country	:	US
Telephone Number	:	480-855-6075
Fax Number	:	888-237-7954

Provider Business Practice Location Address
First Line	:	2875 W RAY RD
Second Line	:	SUITE 16
City	:	CHANDLER
State	:	AZ
Zip	:	85224-3524
Country	:	US
Telephone Number	:	480-855-6075
Fax Number	:	888-237-7954

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	09/11/2009

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