Healthcare Provider Details

I. General information

NPI: 1730480948
Provider Name (Legal Business Name): KATIE E HARTMAN RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1839 MANTON ST
PHILADELPHIA PA
19146-2922
US

IV. Provider business mailing address

1839 MANTON ST
PHILADELPHIA PA
19146-2922
US

V. Phone/Fax

Practice location:
  • Phone: 215-827-6701
  • Fax:
Mailing address:
  • Phone: 215-827-6701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN004404
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: