Healthcare Provider Details

I. General information

NPI: 1669539284
Provider Name (Legal Business Name): CHRISTINA ANNE HASEMANN PH.D., R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 LA GRANGE ST
BINGHAMTON NY
13905-1718
US

IV. Provider business mailing address

74 LA GRANGE ST
BINGHAMTON NY
13905-1718
US

V. Phone/Fax

Practice location:
  • Phone: 607-770-6221
  • Fax: 607-770-6221
Mailing address:
  • Phone: 607-770-6221
  • Fax: 607-770-6221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number000732
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: