Provider Demographics
NPI:1851774509
Name:HOLDER, KATHERINE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:HOLDER
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 1:10 COVENT GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-1902
Mailing Address - Country:US
Mailing Address - Phone:336-455-2358
Mailing Address - Fax:
Practice Address - Street 1:10 COVENT GARDEN CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-1902
Practice Address - Country:US
Practice Address - Phone:336-455-2358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004013133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered