Healthcare Provider Details

I. General information

NPI: 1518755990
Provider Name (Legal Business Name): KATE REGAN NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 WEST AVE
WAYNE PA
19087-3307
US

IV. Provider business mailing address

316 WEST AVE
WAYNE PA
19087-3307
US

V. Phone/Fax

Practice location:
  • Phone: 484-889-6393
  • Fax:
Mailing address:
  • Phone: 484-889-6393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: KATE REGAN
Title or Position: OWNER
Credential: RDN
Phone: 484-889-6393