Provider Demographics
NPI:1316171267
Name:ULLRICH, TONI CHRISTINE (RD/LD/N)
Entity type:Individual
Prefix:MS
First Name:TONI
Middle Name:CHRISTINE
Last Name:ULLRICH
Suffix:
Gender:F
Credentials:RD/LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 BLAINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-2518
Mailing Address - Country:US
Mailing Address - Phone:724-658-3912
Mailing Address - Fax:
Practice Address - Street 1:1410 BLAINE ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-2518
Practice Address - Country:US
Practice Address - Phone:724-714-5698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001112133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered