Provider Demographics
NPI:1740894757
Name:OHMER, MARLENE ROSE (RD, LDN FSP)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:ROSE
Last Name:OHMER
Suffix:
Gender:F
Credentials:RD, LDN FSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2547 W 8TH ST UNIT 42
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4443
Mailing Address - Country:US
Mailing Address - Phone:814-315-9537
Mailing Address - Fax:
Practice Address - Street 1:2547 W 8TH ST UNIT 42
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4443
Practice Address - Country:US
Practice Address - Phone:814-315-9537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA833205133N00000X, 133VN1005X, 133VN1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Gerontological
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal