Healthcare Provider Details

I. General information

NPI: 1033996459
Provider Name (Legal Business Name): EVE PENUEL RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 LIBERTY AVE STE 215
PITTSBURGH PA
15224-2156
US

IV. Provider business mailing address

5562 HOBART ST APT 702
PITTSBURGH PA
15217-1995
US

V. Phone/Fax

Practice location:
  • Phone: 412-578-1026
  • Fax:
Mailing address:
  • Phone: 856-701-0266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN008215
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: