Basic Information
| Provider Information | |||||||||
| NPI: | 1619017241 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCFADDEN | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | |||||||||
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| Credential: | R.D., CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5092 | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947050092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106491573 | ||||||||
| FaxNumber: | 5108872470 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 W BEAMER ST | ||||||||
| Address2: | |||||||||
| City: | WOODLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956952510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5304052900 | ||||||||
| FaxNumber: | 5302045255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 02/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 706478 | CA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.