Provider Demographics
NPI:1467880294
Name:BOGART, CATRINA O'MATHUNA (RD, LD)
Entity Type:Individual
Prefix:
First Name:CATRINA
Middle Name:O'MATHUNA
Last Name:BOGART
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:CATRINA
Other - Middle Name:LYNN
Other - Last Name:O'MATHUNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:3999 WYNDING DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3134
Mailing Address - Country:US
Mailing Address - Phone:614-309-7897
Mailing Address - Fax:
Practice Address - Street 1:401 N EWING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130
Practice Address - Country:US
Practice Address - Phone:740-687-8967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-14
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7301133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered