Provider Demographics
NPI:1487925285
Name:LAMANTIA, PATRICIA ANN (RD, LD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:LAMANTIA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:QUACKENBUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:5340 E MAIN ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2574
Mailing Address - Country:US
Mailing Address - Phone:614-864-7225
Mailing Address - Fax:614-864-2207
Practice Address - Street 1:5340 E MAIN ST
Practice Address - Street 2:SUITE 111
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2574
Practice Address - Country:US
Practice Address - Phone:614-864-7225
Practice Address - Fax:614-864-2207
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6884133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered