Healthcare Provider Details

I. General information

NPI: 1053825174
Provider Name (Legal Business Name): KATHRYN ELIZABETH LANDEL RD, LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 N CENTRAL EXPY STE 370
DALLAS TX
75231-5947
US

IV. Provider business mailing address

9101 N CENTRAL EXPY STE 370
DALLAS TX
75231-5947
US

V. Phone/Fax

Practice location:
  • Phone: 215-820-8220
  • Fax: 214-820-8219
Mailing address:
  • Phone: 214-820-2969
  • Fax: 214-820-8219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86052291
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: