Provider Demographics
NPI:1598538100
Name:HARDEN, ADRIENNE E
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:E
Last Name:HARDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 WYLDEROSE CMNS STE 200
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-6918
Mailing Address - Country:US
Mailing Address - Phone:804-592-0095
Mailing Address - Fax:
Practice Address - Street 1:250 WYLDEROSE CMNS STE 200
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-6918
Practice Address - Country:US
Practice Address - Phone:804-592-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86110606133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered