=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225798804
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA M KATZBERG RD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2021
-----------------------------------------------------
Last Update Date | 12/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 S PROSSER AVE
-----------------------------------------------------
City | JUNIATA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68955-2054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-469-5643
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 S PROSSER AVE
-----------------------------------------------------
City | JUNIATA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68955-2054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-469-5643
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 883234
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------