Provider Demographics
NPI:1790318053
Name:KRETCHIK, ANN MARIE ELIZABETH (MS, RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:ANN MARIE
Middle Name:ELIZABETH
Last Name:KRETCHIK
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 PARK ST
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1498
Mailing Address - Country:US
Mailing Address - Phone:570-253-8164
Mailing Address - Fax:570-251-6575
Practice Address - Street 1:601 PARK ST
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1498
Practice Address - Country:US
Practice Address - Phone:570-253-8164
Practice Address - Fax:570-251-6575
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005393133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered