Provider Demographics
NPI:1487743779
Name:KALISTA-RICHARDS, MARCIA ANN (MPH RD CNSO LDN)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:ANN
Last Name:KALISTA-RICHARDS
Suffix:
Gender:F
Credentials:MPH RD CNSO LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7226 WHISPERING LN
Mailing Address - Street 2:
Mailing Address - City:SLATINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18080-2236
Mailing Address - Country:US
Mailing Address - Phone:610-760-1310
Mailing Address - Fax:610-760-0214
Practice Address - Street 1:601 8TH ST
Practice Address - Street 2:CKD SERVICES OF FULLERTON
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-5701
Practice Address - Country:US
Practice Address - Phone:610-266-5811
Practice Address - Fax:610-266-5815
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000888133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered