MEDICARE: JANET MEINDERS CHARALAMPOUS R.D., L.D.10

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	LD 25	OK

General Provider Information

NPI Number	:	1891782884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET MEINDERS CHARALAMPOUS R.D., L.D.10

Provider Business Mailing Address
First Line	:	PO BOX 155
Second Line	:
City	:	DAVIS
State	:	OK
Zip	:	73030-0155
Country	:	US
Telephone Number	:	580-369-3636
Fax Number	:	580-369-3366

Provider Business Practice Location Address
First Line	:	HC 67 BOX 1
Second Line	:
City	:	DAVIS
State	:	OK
Zip	:	73030-9501
Country	:	US
Telephone Number	:	580-369-3636
Fax Number	:	580-369-3366

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	07/08/2007

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