Provider Demographics
NPI:1578624557
Name:HOHENBRINK, KATHY LYNN (RD,,LD,DCDE)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:LYNN
Last Name:HOHENBRINK
Suffix:
Gender:F
Credentials:RD,,LD,DCDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 W ARBOR POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-2686
Mailing Address - Country:US
Mailing Address - Phone:208-318-6239
Mailing Address - Fax:208-463-5725
Practice Address - Street 1:1512 12TH AVENUE ROAD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686
Practice Address - Country:US
Practice Address - Phone:208-463-5728
Practice Address - Fax:208-463-5725
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-027133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1940345Medicare ID - Type Unspecified
IDP86938Medicare UPIN