Provider Demographics
NPI:1154453603
Name:HARDY-WHITE, RITA (RD,CDE,LD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:HARDY-WHITE
Suffix:
Gender:F
Credentials:RD,CDE,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 NW 39TH TER
Mailing Address - Street 2:#204
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1017
Mailing Address - Country:US
Mailing Address - Phone:954-802-9502
Mailing Address - Fax:954-717-3790
Practice Address - Street 1:2521 NW 39TH TER
Practice Address - Street 2:#204
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33311-1017
Practice Address - Country:US
Practice Address - Phone:954-802-9502
Practice Address - Fax:954-717-3790
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3231133NN1002X, 133VN1005X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Not Answered133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Not Answered133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5236Medicare ID - Type Unspecified