Provider Demographics
NPI:1720344195
Name:WERNER, KATHERINE ALICE (RD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ALICE
Last Name:WERNER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:850 ENTERPRISE PKWY
Practice Address - Street 2:SUITE 1300
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6251
Practice Address - Country:US
Practice Address - Phone:757-637-7637
Practice Address - Fax:757-637-7642
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered