MEDICARE: MRS. ANGELA N REEMELIN RD

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	0000095	FL

General Provider Information

NPI Number	:	1851439491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA N REEMELIN RD

Provider Business Mailing Address
First Line	:	601 LORN CT
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4228
Country	:	US
Telephone Number	:	904-276-4830
Fax Number	:	904-298-0283

Provider Business Practice Location Address
First Line	:	601 LORN CT
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4228
Country	:	US
Telephone Number	:	904-276-4830
Fax Number	:	904-298-0283

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

Provider Enumeration Date	:	02/04/2007
Last Update Date	:	07/08/2007

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