Provider Demographics
NPI:1689821548
Name:MOHAN, CHRISTINE (RD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MOHAN
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 1:562 SHEARER ST
Mailing Address - Street 2:G100
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2746
Mailing Address - Country:US
Mailing Address - Phone:866-276-0600
Mailing Address - Fax:
Practice Address - Street 1:562 SHEARER ST
Practice Address - Street 2:G100
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2746
Practice Address - Country:US
Practice Address - Phone:866-276-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001453133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA134740ZBNWMedicare UPIN