Healthcare Provider Details

I. General information

NPI: 1104042043
Provider Name (Legal Business Name): JOANNE RYCZAK RD CDE LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MAIN ST MID VALLEY HOSPITAL
PECKVILLE PA
18452
US

IV. Provider business mailing address

203 HOSPITAL ST
PECKVILLE PA
18452-1125
US

V. Phone/Fax

Practice location:
  • Phone: 570-383-5622
  • Fax: 570-383-5603
Mailing address:
  • Phone: 570-383-5622
  • Fax: 570-383-5603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN000809
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: