Provider Demographics
NPI:1396486692
Name:MITCHELL, KATHERINE (RD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 ELM ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1473
Mailing Address - Country:US
Mailing Address - Phone:781-539-5909
Mailing Address - Fax:
Practice Address - Street 1:211 ELM ST APT 2
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1473
Practice Address - Country:US
Practice Address - Phone:781-539-5909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-02
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA86198992133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered