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General NPI Number Information
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NPI Number | 1558033670
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Entity Type | Individual
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Provider Name | NINA KATHERINE LA MARCA RD, LD
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Gender | Female
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Dates
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Enumeration Date | 09/28/2021
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Last Update Date | 09/14/2024
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Provider Practice Location Address
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Address Line | 4160 PEACH TREE LN
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City | RICHMOND
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State | IN
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Zip | 47374-4714
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Country | US
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Telephone | 655-530-9167
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Fax |
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Provider Business Mailing Address
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Address Line | 4160 PEACH TREE LN
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City | RICHMOND
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State | IN
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Zip | 47374-4714
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1301X
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Taxonomy Name | Oncology Nutrition Registered Dietitian
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License Number | 37002885A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 2041
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 718631
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License Number State |
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