Healthcare Provider Details

I. General information

NPI: 1093308736
Provider Name (Legal Business Name): KATHERINE WARDEN DTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2021
Last Update Date: 02/13/2021
Certification Date: 02/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 PAUL RD
WESTERVILLE OH
43082-9031
US

IV. Provider business mailing address

6501 PAUL RD
WESTERVILLE OH
43082-9031
US

V. Phone/Fax

Practice location:
  • Phone: 614-832-6558
  • Fax:
Mailing address:
  • Phone: 614-832-6558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: