Healthcare Provider Details

I. General information

NPI: 1730238346
Provider Name (Legal Business Name): KATHRYN WRENN-KLEIMAN RD LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 ELM ST
MANCHESTER NH
03101-1308
US

IV. Provider business mailing address

36 MATHES HILL DR
DOVER NH
03820-4492
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-6629
  • Fax:
Mailing address:
  • Phone: 603-767-7016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number207
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: