Provider Demographics
NPI:1578783882
Name:WEHNAU, DOROTHY A (RD)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:A
Last Name:WEHNAU
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 US ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:SCHROON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12870-2603
Mailing Address - Country:US
Mailing Address - Phone:518-796-8672
Mailing Address - Fax:
Practice Address - Street 1:75 PARK ST
Practice Address - Street 2:ELIZABETHTOWN COMMUNITY HOSPITAL
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NY
Practice Address - Zip Code:12932-0075
Practice Address - Country:US
Practice Address - Phone:518-873-3106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA6665Medicare ID - Type UnspecifiedDOROTHY A. WEHNAU MNT