Provider Demographics
NPI:1801439013
Name:KARNER, HEIDI ELISE (RDN)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:ELISE
Last Name:KARNER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 HARVEY ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1721
Mailing Address - Country:US
Mailing Address - Phone:765-749-7880
Mailing Address - Fax:
Practice Address - Street 1:1 JOSLIN PL OFC 208
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5394
Practice Address - Country:US
Practice Address - Phone:617-309-2438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT86110291133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered