Provider Demographics
NPI:1174983225
Name:VICINI, KATHRYN DIANE (RD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DIANE
Last Name:VICINI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:RURAL VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:16249-0071
Mailing Address - Country:US
Mailing Address - Phone:724-525-1392
Mailing Address - Fax:
Practice Address - Street 1:960 PENN AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-3818
Practice Address - Country:US
Practice Address - Phone:412-288-2130
Practice Address - Fax:412-288-9036
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA86029058133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered