Provider Demographics
NPI:1477764199
Name:TEWELL, NANCY E (LDN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:E
Last Name:TEWELL
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 OLD FREDONIA RD
Mailing Address - Street 2:
Mailing Address - City:MERCER
Mailing Address - State:PA
Mailing Address - Zip Code:16137-4725
Mailing Address - Country:US
Mailing Address - Phone:724-662-7879
Mailing Address - Fax:724-662-1316
Practice Address - Street 1:2120 LIKENS LN
Practice Address - Street 2:SUITE 100
Practice Address - City:FARRELL
Practice Address - State:PA
Practice Address - Zip Code:16121-2304
Practice Address - Country:US
Practice Address - Phone:724-662-7879
Practice Address - Fax:724-662-1316
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003534133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA113468PVDMedicare PIN