Healthcare Provider Details

I. General information

NPI: 1760072128
Provider Name (Legal Business Name): KATHERINE OLDERMAN MS, CNS, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 01/20/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 RUGBY AVE APT 1201
BETHESDA MD
20814-7104
US

IV. Provider business mailing address

4850 RUGBY AVE APT 1201
BETHESDA MD
20814-7104
US

V. Phone/Fax

Practice location:
  • Phone: 301-412-4321
  • Fax:
Mailing address:
  • Phone: 301-412-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX5178
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: