Basic Information
| Provider Information | |||||||||
| NPI: | 1295014751 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LENEGHAN | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RD LD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SUTZ | ||||||||
| OtherFirstName: | KIMBERLY | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 615 FULTON ST | ||||||||
| Address2: | |||||||||
| City: | PORT CLINTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434522001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197343131 | ||||||||
| FaxNumber: | 4197324087 | ||||||||
| Practice Location | |||||||||
| Address1: | 615 FULTON ST | ||||||||
| Address2: | |||||||||
| City: | PORT CLINTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434522001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197343131 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2011 | ||||||||
| LastUpdateDate: | 07/26/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 4874 | OH | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.