Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CH8876 | FL |
NPI | 1154336592 |
---|---|
Provider Name | Ann Rhame |
First Address | Clearwater, FL 33759-1353 |
Second Address | Clearwater, FL 33759-1353 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 30/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89764A | MEDICARE PTAN (01) |