MR. Clinton Harold Wattenberg, RD

NPI #1942580501 in Ithaca, New York

Provider Information

NPI Number: 1942580501
Entity Type: Individual
Name: MR. Clinton Harold Wattenberg, RD
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dietitian, Registered
Credential: RD
Enumeration Date: Aug 26, 2011
Last Updated: Aug 26, 2011

Practice Location

Address: 949 E STATE ST
City: Ithaca
State: New York
ZIP Code: 14850-6158
Phone: (607) 227-9344

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dietitian, Registered	133V00000X	Primary
Dietitian, Registered - Nutrition, Pediatric — Nutrition, Pediatric	133VN1004X
Dietitian, Registered - Nutrition, Metabolic — Nutrition, Metabolic	133VN1006X
Student in an Organized Health Care Education/Training Program	390200000X

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