Provider Demographics
NPI:1083657720
Name:REINHARD, JOAN LYNN (MS, RD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:LYNN
Last Name:REINHARD
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 HAMILTON ST
Mailing Address - Street 2:PO BOX 42
Mailing Address - City:BOWMANSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18030
Mailing Address - Country:US
Mailing Address - Phone:610-852-3838
Mailing Address - Fax:
Practice Address - Street 1:168 SGT. STANLEY HOFFMAN BLVD., RTE. 209 BYPASS
Practice Address - Street 2:BMA OF CARBON COUNTY - CKD SERVICES
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235
Practice Address - Country:US
Practice Address - Phone:610-379-0330
Practice Address - Fax:610-376-0336
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001596133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
057245ETDMedicare UPIN