MEDICARE: CELESTA LYMAN R.D. C. D.

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	324772-4901	UT

General Provider Information

NPI Number	:	1912183039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELESTA LYMAN R.D. C. D.

Provider Business Mailing Address
First Line	:	4781 N 1170 E
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-7433
Country	:	US
Telephone Number	:	435-586-2447
Fax Number	:

Provider Business Practice Location Address
First Line	:	4781 N 1170 E
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-7433
Country	:	US
Telephone Number	:	435-586-2447
Fax Number	:

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

Provider Enumeration Date	:	01/18/2008
Last Update Date	:	01/18/2008

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