MEDICARE: LAUREN EILEEN WHALEY R.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

General Provider Information

NPI Number	:	1992146096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN EILEEN WHALEY R.D.

Provider Business Mailing Address
First Line	:	PO BOX 4208
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65808-4208
Country	:	US
Telephone Number	:	417-521-3598
Fax Number	:

Provider Business Practice Location Address
First Line	:	2740 N MAYFAIR AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65803-5084
Country	:	US
Telephone Number	:	417-521-3598
Fax Number	:

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

Provider Enumeration Date	:	07/17/2013
Last Update Date	:	07/17/2013

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