Organization
MEDICAL NUTRITION GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATI L LOYACONO MS, RD, LD (DIRECTOR)
(228) 493-2877
Entity
Organization
Contact information
Practice address
250 LAKE VILLAGE DR, MADISON, MS 39110-6522
(228) 493-2877
Mailing address
250 LAKE VILLAGE DR, MADISON, MS 39110-6522
(228) 493-2877
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D1026
MS
Other
Enumeration date
02/03/2009
Last updated
02/03/2009
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