MEDICARE: BRIGIT DOOLEY MS, RDN, LD

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	LD0915	NM

General Provider Information

NPI Number	:	1891196184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIGIT DOOLEY MS, RDN, LD

Provider Business Mailing Address
First Line	:	4215 SOTOL DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-7689
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 N ALAMEDA BLVD
Second Line	:	STE 3
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-2291
Country	:	US
Telephone Number	:	575-649-0450
Fax Number	:

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

Provider Enumeration Date	:	09/05/2014
Last Update Date	:	11/06/2014

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