Provider Demographics
NPI:1093262214
Name:MARETT, KELLIE MAXINE (RD)
Entity Type:Individual
Prefix:MISS
First Name:KELLIE
Middle Name:MAXINE
Last Name:MARETT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 GRIM RD
Mailing Address - Street 2:
Mailing Address - City:VOLANT
Mailing Address - State:PA
Mailing Address - Zip Code:16156-4710
Mailing Address - Country:US
Mailing Address - Phone:724-730-5027
Mailing Address - Fax:
Practice Address - Street 1:3023 WILMINGTON RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1242
Practice Address - Country:US
Practice Address - Phone:724-656-8814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered