Healthcare Provider Details

I. General information

NPI: 1659564169
Provider Name (Legal Business Name): MISS KARA AHLBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 S BELMONT ST
YORK PA
17403-2608
US

IV. Provider business mailing address

325 S BELMONT ST
YORK PA
17403-2608
US

V. Phone/Fax

Practice location:
  • Phone: 717-843-8623
  • Fax:
Mailing address:
  • Phone: 717-843-8623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDN003574
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: