Healthcare Provider Details

I. General information

NPI: 1477963114
Provider Name (Legal Business Name): JUDITH HUFNAGEL R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2014
Last Update Date: 05/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 4TH AVE
NEW EAGLE PA
15067-1502
US

IV. Provider business mailing address

114 4TH AVE
NEW EAGLE PA
15067-1502
US

V. Phone/Fax

Practice location:
  • Phone: 724-249-3208
  • Fax:
Mailing address:
  • Phone: 724-249-3208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN004642
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: