Provider Demographics
NPI:1316020019
Name:HIZA, KATHERINE (DT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:HIZA
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:TERRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:58 MCCRILLIS RD
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03290-5206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:207 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWMARKET
Practice Address - State:NH
Practice Address - Zip Code:03857-1843
Practice Address - Country:US
Practice Address - Phone:603-659-3106
Practice Address - Fax:603-659-8003
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH54133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered