MEDICARE: COURTNEY RINEHOLD R.D., C.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	37001842A	IN
2	133VN1005X	Renal Nutrition Registered Dietitian	37001842A	IN

General Provider Information

NPI Number	:	1750623591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY RINEHOLD R.D., C.D.

Provider Business Mailing Address
First Line	:	1607 GLACIER RIDGE RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-9720
Country	:	US
Telephone Number	:	260-494-7235
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 GLACIER RIDGE RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-9720
Country	:	US
Telephone Number	:	260-494-7235
Fax Number	:

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

Provider Enumeration Date	:	03/19/2013
Last Update Date	:	04/28/2013

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