Provider Demographics
NPI:1417195637
Name:HOSS, KATHLEEN MARIE (MPH, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:HOSS
Suffix:
Gender:F
Credentials:MPH, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 ROMA AVE NE
Mailing Address - Street 2:DINING SERVICES, MANZANO DEL SOL
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1334
Mailing Address - Country:US
Mailing Address - Phone:505-262-2311
Mailing Address - Fax:505-262-2426
Practice Address - Street 1:5201 ROMA AVE NE
Practice Address - Street 2:DINING SERVICES, MANZANO DEL SOL
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1334
Practice Address - Country:US
Practice Address - Phone:505-262-2311
Practice Address - Fax:505-262-2426
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD-0698133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered