Provider Demographics
NPI:1801957600
Name:HARTZLER, HOLLY RENAE (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:RENAE
Last Name:HARTZLER
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6329 EVANS CREEK RD SW
Mailing Address - Street 2:
Mailing Address - City:STONE CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:43840-9502
Mailing Address - Country:US
Mailing Address - Phone:330-340-9952
Mailing Address - Fax:
Practice Address - Street 1:659 BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2026
Practice Address - Country:US
Practice Address - Phone:330-343-3311
Practice Address - Fax:330-602-0710
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5854133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered