Healthcare Provider Details

I. General information

NPI: 1891700555
Provider Name (Legal Business Name): JOANNE C, SEKERAK RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 NEW CASTLE RD
BUTLER PA
16001-2418
US

IV. Provider business mailing address

2023 MENOLD DR
ALLISON PARK PA
15101-2837
US

V. Phone/Fax

Practice location:
  • Phone: 724-285-2432
  • Fax: 724-477-5069
Mailing address:
  • Phone: 412-366-7258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN001598
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: