Provider Demographics
NPI:1538356514
Name:NITZSCHE, PATRICIA CAMPBELL (RDLD)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:CAMPBELL
Last Name:NITZSCHE
Suffix:
Gender:F
Credentials:RDLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6847 N CHESTNUT ST
Mailing Address - Street 2:HEALTH EDUCATION DEPARTMENT
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3929
Mailing Address - Country:US
Mailing Address - Phone:330-677-1552
Mailing Address - Fax:330-677-1345
Practice Address - Street 1:401 DEVON PL
Practice Address - Street 2:DIABETES CARE AND EDUCATION
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-6482
Practice Address - Country:US
Practice Address - Phone:330-677-1552
Practice Address - Fax:330-677-1345
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1126133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered