Provider Demographics
NPI:1376830166
Name:HENNEMANN, KATHERINE ELIZABETH (RD, LD, CNSC)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:HENNEMANN
Suffix:
Gender:F
Credentials:RD, LD, CNSC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ELIZABETH
Other - Last Name:BOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 W AGENCY RD
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1659
Mailing Address - Country:US
Mailing Address - Phone:319-768-4100
Mailing Address - Fax:319-768-3412
Practice Address - Street 1:1401 W AGENCY RD
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1659
Practice Address - Country:US
Practice Address - Phone:319-768-4100
Practice Address - Fax:319-768-3412
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01393133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1134168263OtherHOSPITAL NPI #