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NPI Code Detail

MEDICARE: MRS. AYN TANYA PAVEK RD, LD

MEDICARE: MRS. AYN TANYA PAVEK RD, 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
1133V00000XRegistered Dietitian2662MN

General Provider Information

NPI Number : 1982044905
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AYN TANYA PAVEK RD, LD
Provider Business Mailing Address
First Line : 1920 GRANT ST NW
Second Line :
City : FARIBAULT
State : MN
Zip : 55021-4831
Country : US
Telephone Number : 507-334-2085
Fax Number :
Provider Business Practice Location Address
First Line : 1920 GRANT ST NW
Second Line :
City : FARIBAULT
State : MN
Zip : 55021-4831
Country : US
Telephone Number : 507-334-2085
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2013
Last Update Date : 07/05/2013

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