Provider Demographics
NPI:1558515296
Name:MARRA, KATHERINE D (CD-N)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:D
Last Name:MARRA
Suffix:
Gender:F
Credentials:CD-N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 NEW SCOTLAND AVE
Mailing Address - Street 2:MC 88
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208
Mailing Address - Country:US
Mailing Address - Phone:518-262-5410
Mailing Address - Fax:518-262-5924
Practice Address - Street 1:47 NEW SCOTLAND AVE
Practice Address - Street 2:MC 88
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-5410
Practice Address - Fax:518-262-5924
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004888133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist