Provider Demographics
NPI:1790318053
Name:KRETCHIK, ANN MARIE ELIZABETH (MS, RD, LDN)
Entity type:Individual
Prefix:MS
First Name:ANN MARIE
Middle Name:ELIZABETH
Last Name:KRETCHIK
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 BROOKLYN ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-2801
Mailing Address - Country:US
Mailing Address - Phone:570-267-6594
Mailing Address - Fax:
Practice Address - Street 1:203 BROOKLYN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-2801
Practice Address - Country:US
Practice Address - Phone:570-267-6594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005393133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered