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NPI Code Detail

MEDICARE: INGE DAESCHEL R.D., L.D.

MEDICARE: INGE DAESCHEL R.D., L.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
1133VN1004XPediatric Nutrition Registered Dietitian276OR

General Provider Information

NPI Number : 1700070620
Entity Type Code : Individual
Provider Name (Legal Business Name) : INGE DAESCHEL R.D., L.D.
Provider Business Mailing Address
First Line : 1810 BULLEVARD
Second Line :
City : PHILOMATH
State : OR
Zip : 97370-9538
Country : US
Telephone Number : 541-929-4773
Fax Number :
Provider Business Practice Location Address
First Line : 523 SE WASHINGTON STREET
Second Line :
City : DALLAS
State : OR
Zip : 97338-2834
Country : US
Telephone Number : 503-623-7307
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2007
Last Update Date : 09/04/2007

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