Provider Demographics
NPI:1821314691
Name:MICAHNIK, HELENE H, C (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:HELENE
Middle Name:H, C
Last Name:MICAHNIK
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 1:1710 BORBECK AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-3515
Mailing Address - Country:US
Mailing Address - Phone:215-742-1021
Mailing Address - Fax:
Practice Address - Street 1:1600 GRIFFITH ST APT 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2932
Practice Address - Country:US
Practice Address - Phone:215-742-1021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003965133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102466525Medicaid