Healthcare Provider Details

I. General information

NPI: 1083657720
Provider Name (Legal Business Name): JOAN LYNN REINHARD MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 SGT. STANLEY HOFFMAN BLVD., RTE. 209 BYPASS BMA OF CARBON COUNTY - CKD SERVICES
LEHIGHTON PA
18235
US

IV. Provider business mailing address

624 HAMILTON ST PO BOX 42
BOWMANSTOWN PA
18030
US

V. Phone/Fax

Practice location:
  • Phone: 610-379-0330
  • Fax: 610-376-0336
Mailing address:
  • Phone: 610-852-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberDN001596
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: