Provider Demographics
NPI:1902922776
Name:LITSCHE, MILDRED E
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:E
Last Name:LITSCHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4516 STATE ROUTE 64
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-9309
Mailing Address - Country:US
Mailing Address - Phone:585-229-2016
Mailing Address - Fax:
Practice Address - Street 1:316 ELM ST
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1410
Practice Address - Country:US
Practice Address - Phone:315-536-6241
Practice Address - Fax:315-536-8773
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0024761133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered