Basic Information
| Provider Information | |||||||||
| NPI: | 1558636837 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANDER | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RD,LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 WHEELING AVE | ||||||||
| Address2: | |||||||||
| City: | GLEN DALE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260381660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048433479 | ||||||||
| FaxNumber: | 3048433202 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 WHEELING AVE | ||||||||
| Address2: | |||||||||
| City: | GLEN DALE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260381660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048433479 | ||||||||
| FaxNumber: | 3048433202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2012 | ||||||||
| LastUpdateDate: | 03/20/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 350 | WV | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.