Healthcare Provider Details

I. General information

NPI: 1376830166
Provider Name (Legal Business Name): KATHERINE ELIZABETH HENNEMANN RD, LD, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE ELIZABETH BOWARD

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W AGENCY RD
WEST BURLINGTON IA
52655-1659
US

IV. Provider business mailing address

1401 W AGENCY RD
WEST BURLINGTON IA
52655-1659
US

V. Phone/Fax

Practice location:
  • Phone: 319-768-4100
  • Fax: 319-768-3412
Mailing address:
  • Phone: 319-768-4100
  • Fax: 319-768-3412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number01393
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: