Provider Demographics
NPI:1831967116
Name:WERNER, CHARLOTTE MARIE (MS, RD, CDN)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:MARIE
Last Name:WERNER
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W 84TH ST APT 1E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4207
Mailing Address - Country:US
Mailing Address - Phone:718-938-4129
Mailing Address - Fax:
Practice Address - Street 1:320 W 84TH ST APT 1E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4207
Practice Address - Country:US
Practice Address - Phone:718-938-4129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010166133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty