Healthcare Provider Details

I. General information

NPI: 1174138069
Provider Name (Legal Business Name): CORISSA M ALBERT MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N HANOVER ST
CARLISLE PA
17013-1598
US

IV. Provider business mailing address

801 N HANOVER ST
CARLISLE PA
17013-1599
US

V. Phone/Fax

Practice location:
  • Phone: 717-249-5322
  • Fax:
Mailing address:
  • Phone: 717-357-5677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN006711
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: