Provider Demographics
NPI:1922017375
Name:DENNISON, KATHERINE MICHELLE (MPH RD LD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MICHELLE
Last Name:DENNISON
Suffix:
Gender:F
Credentials:MPH RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4540 MACARTHUR BLVD NW
Mailing Address - Street 2:#B5
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-4247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4540 MACARTHUR BLVD NW
Practice Address - Street 2:#B5
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-4247
Practice Address - Country:US
Practice Address - Phone:917-532-1819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered