Provider Demographics
NPI:1285039255
Name:HOLLENBACH, TRICIA ANN (RDN)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:ANN
Last Name:HOLLENBACH
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2239 ERDLEY CHURCH ROAD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842
Mailing Address - Country:US
Mailing Address - Phone:570-486-1818
Mailing Address - Fax:
Practice Address - Street 1:2239 ERDLEY CHURCH ROAD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:PA
Practice Address - Zip Code:17842
Practice Address - Country:US
Practice Address - Phone:570-486-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005201133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered