Healthcare Provider Details

I. General information

NPI: 1740614213
Provider Name (Legal Business Name): ANNETTE JEANINE HOTTENSTEIN MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2013
Last Update Date: 09/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17010 YORK RD
PARKTON MD
21120-9719
US

IV. Provider business mailing address

16003 YORK RD
SPARKS GLENCOE MD
21152-9380
US

V. Phone/Fax

Practice location:
  • Phone: 410-215-7549
  • Fax:
Mailing address:
  • Phone: 410-343-9209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX3376
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: