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NPI Code Detail

MEDICARE: MRS. DONNA FOGLEMAN NELSON RD

MEDICARE: MRS. DONNA FOGLEMAN NELSON RD
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 Dietitian604LA

General Provider Information

NPI Number : 1982692489
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DONNA FOGLEMAN NELSON RD
Provider Business Mailing Address
First Line : 474 HIGHWAY 866
Second Line :
City : WINNSBORO
State : LA
Zip : 71295-5562
Country : US
Telephone Number : 318-435-6294
Fax Number : 318-330-7715
Provider Business Practice Location Address
First Line : 4864 JACKSON ST
Second Line :
City : MONROE
State : LA
Zip : 71202-6400
Country : US
Telephone Number : 318-330-7714
Fax Number : 318-330-7715
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2005
Last Update Date : 07/08/2007

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