Provider Demographics
NPI:1750660833
Name:HARNETT, COLLEEN MOSS (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MOSS
Last Name:HARNETT
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8705 JANS CT
Mailing Address - Street 2:
Mailing Address - City:BOONSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21713-1747
Mailing Address - Country:US
Mailing Address - Phone:301-733-9516
Mailing Address - Fax:301-791-6272
Practice Address - Street 1:8705 JANS CT
Practice Address - Street 2:
Practice Address - City:BOONSBORO
Practice Address - State:MD
Practice Address - Zip Code:21713-1747
Practice Address - Country:US
Practice Address - Phone:301-733-9516
Practice Address - Fax:301-791-6272
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00542133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD00542OtherMARYLAND BOARD OF DIETETIC PRACTICE