Provider Demographics
NPI:1023770237
Name:HARTENSTINE, JOHNNA R (MCN,RDN,LD)
Entity type:Individual
Prefix:
First Name:JOHNNA
Middle Name:R
Last Name:HARTENSTINE
Suffix:
Gender:F
Credentials:MCN,RDN,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3663 SOLANO AVE APT 192
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2774
Mailing Address - Country:US
Mailing Address - Phone:480-254-7391
Mailing Address - Fax:
Practice Address - Street 1:100 N CENTRAL EXPY STE 409
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5311
Practice Address - Country:US
Practice Address - Phone:214-838-8237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86116632133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered