Provider Demographics
NPI:1598093585
Name:KEARNEY, DANA L (LDN)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:L
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:L
Other - Last Name:REESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LDN
Mailing Address - Street 1:82 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-1914
Mailing Address - Country:US
Mailing Address - Phone:570-282-2210
Mailing Address - Fax:
Practice Address - Street 1:82 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-1914
Practice Address - Country:US
Practice Address - Phone:570-282-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002000133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered