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NPI Code Detail

MEDICARE: NORMA JEAN SLAGLE RD LD CDE

MEDICARE: NORMA JEAN SLAGLE RD LD CDE
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
1133V00000XRegistered Dietitian541KS

General Provider Information

NPI Number : 1942201447
Entity Type Code : Individual
Provider Name (Legal Business Name) : NORMA JEAN SLAGLE RD LD CDE
Provider Business Mailing Address
First Line : 1105 SUNSET AVE
Second Line :
City : MANHATTAN
State : KS
Zip : 66502-3739
Country : US
Telephone Number : 785-587-4275
Fax Number : 785-587-4288
Provider Business Practice Location Address
First Line : 1105 SUNSET AVE
Second Line :
City : MANHATTAN
State : KS
Zip : 66502-3739
Country : US
Telephone Number : 785-587-4275
Fax Number : 785-587-4288
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 07/08/2007

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Directions to “ NORMA JEAN SLAGLE RD LD CDE” Practice Location

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