Provider Demographics
NPI:1760072128
Name:OLDERMAN, KATHERINE (MS, CNS, LDN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:OLDERMAN
Suffix:
Gender:F
Credentials:MS, CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 RUGBY AVE APT 1201
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-7104
Mailing Address - Country:US
Mailing Address - Phone:301-412-4321
Mailing Address - Fax:
Practice Address - Street 1:4850 RUGBY AVE APT 1201
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-7104
Practice Address - Country:US
Practice Address - Phone:301-412-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5178133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist