Healthcare Provider Details

I. General information

NPI: 1619176161
Provider Name (Legal Business Name): ELAINE MARIE KOHLHEPP R.D., C.S.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2007
Last Update Date: 07/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12418 WILLOW FALLS DR
HERNDON VA
20170-2086
US

IV. Provider business mailing address

12418 WILLOW FALLS DR
HERNDON VA
20170-2086
US

V. Phone/Fax

Practice location:
  • Phone: 703-421-5279
  • Fax:
Mailing address:
  • Phone: 703-421-5279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: