MEDICARE: KATHRYN MARIE SPADA RDN

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	39125-DI-2	NV

General Provider Information

NPI Number	:	1861081168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN MARIE SPADA RDN

Provider Business Mailing Address
First Line	:	11636 ARUBA BEACH AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-7546
Country	:	US
Telephone Number	:	702-286-5956
Fax Number	:

Provider Business Practice Location Address
First Line	:	11636 ARUBA BEACH AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-7546
Country	:	US
Telephone Number	:	702-286-5956
Fax Number	:

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

Provider Enumeration Date	:	01/12/2021
Last Update Date	:	04/08/2024

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