Healthcare Provider Details

I. General information

NPI: 1053920223
Provider Name (Legal Business Name): KATHLEEN DICHIARA FDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PRINCESS PINE RD
LINCOLN RI
02865-4729
US

IV. Provider business mailing address

2019 SMITH ST
NORTH PROVIDENCE RI
02911-1717
US

V. Phone/Fax

Practice location:
  • Phone: 401-654-7189
  • Fax:
Mailing address:
  • Phone: 401-400-0930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: