Healthcare Provider Details

I. General information

NPI: 1871099390
Provider Name (Legal Business Name): JOANN OTT-SLENKER RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N. DUKE STREET ATTN: FOOD & NUTRITION SERVICES DEPT
LANCASTER PA
17604-3555
US

IV. Provider business mailing address

555 N. DUKE STREET ATTN: FOOD & NUTRITION SERVICES DEPT
LANCASTER PA
17604-3555
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-7791
  • Fax:
Mailing address:
  • Phone: 717-544-7791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberDN004719
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN004719
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: