Healthcare Provider Details

I. General information

NPI: 1689821548
Provider Name (Legal Business Name): CHRISTINE MOHAN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

562 SHEARER ST G100
GREENSBURG PA
15601-2746
US

IV. Provider business mailing address

562 SHEARER ST G100
GREENSBURG PA
15601-2746
US

V. Phone/Fax

Practice location:
  • Phone: 866-276-0600
  • Fax:
Mailing address:
  • Phone: 866-276-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberDN001453
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: