MEDICARE: DEMI MCGAULEY 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		AZ

General Provider Information

NPI Number	:	1861904930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEMI MCGAULEY RDN

Provider Business Mailing Address
First Line	:	7865 W BELL RD # 1147
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-3803
Country	:	US
Telephone Number	:	480-688-1779
Fax Number	:

Provider Business Practice Location Address
First Line	:	7865 W BELL RD # 1147
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-3803
Country	:	US
Telephone Number	:	480-688-1779
Fax Number	:

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

Provider Enumeration Date	:	10/30/2017
Last Update Date	:	09/15/2024

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