Healthcare Provider Details

I. General information

NPI: 1619113636
Provider Name (Legal Business Name): KATHLEEN ALFREDA MAJKA R.D., L.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 BACK RD
PLEASANT POINT ME
04667-4119
US

IV. Provider business mailing address

11 BACK ROAD
PERRY ME
04667
US

V. Phone/Fax

Practice location:
  • Phone: 207-853-0644
  • Fax:
Mailing address:
  • Phone: 207-592-4803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI667
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: