Provider Demographics
NPI:1760109318
Name:HEATHER REYMUNDE WITTMER, REGISTERED DIETITIAN NUTRITIONIST, LLC
Entity Type:Organization
Organization Name:HEATHER REYMUNDE WITTMER, REGISTERED DIETITIAN NUTRITIONIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:REYMUNDE WITTMER
Authorized Official - Suffix:
Authorized Official - Credentials:MS RDN LDN
Authorized Official - Phone:570-709-5909
Mailing Address - Street 1:63 ALEKSANDER BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-9236
Mailing Address - Country:US
Mailing Address - Phone:570-709-5909
Mailing Address - Fax:866-839-4061
Practice Address - Street 1:359 S MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-1984
Practice Address - Country:US
Practice Address - Phone:570-709-5909
Practice Address - Fax:866-839-4061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA86104089OtherCDR REGISTRATION #
PADN007247OtherLICENSURE
PA1609488659OtherINDIVIDUAL NPI