Provider Demographics
NPI:1205604345
Name:TOMKO, JUDITH ANN (RD,LDN)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:TOMKO
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 1:4518 FOXTAIL DR
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-9665
Mailing Address - Country:US
Mailing Address - Phone:610-417-1313
Mailing Address - Fax:
Practice Address - Street 1:4518 FOXTAIL DR
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-9665
Practice Address - Country:US
Practice Address - Phone:610-417-1313
Practice Address - Fax:610-759-6632
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002020133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered