Provider Demographics
NPI:1346341369
Name:HARTSHORN, MARY FRANCES (RD, LD, CDE)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:FRANCES
Last Name:HARTSHORN
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 NEEDY RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25405-5618
Mailing Address - Country:US
Mailing Address - Phone:304-267-2818
Mailing Address - Fax:
Practice Address - Street 1:1851 NEEDY RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25405-5618
Practice Address - Country:US
Practice Address - Phone:304-267-2818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV178133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002714Medicaid
WV001706833OtherBC/BS PAYOR #
WV001706833OtherBC/BS PAYOR #