Healthcare Provider Details

I. General information

NPI: 1306994488
Provider Name (Legal Business Name): KAREN M. HOMAN DIETICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 03/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S MAIN ST
CELINA OH
45822-2413
US

IV. Provider business mailing address

950 S MAIN ST
CELINA OH
45822-2413
US

V. Phone/Fax

Practice location:
  • Phone: 567-890-7127
  • Fax: 419-586-1614
Mailing address:
  • Phone: 567-890-7127
  • Fax: 419-586-1614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number5158
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: