Provider Demographics
NPI:1518501055
Name:KEYSTONE NUTRITION
Entity Type:Organization
Organization Name:KEYSTONE NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NUTRITIONIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:TWEDT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CNS, LDN
Authorized Official - Phone:610-525-1422
Mailing Address - Street 1:512 W LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3122
Mailing Address - Country:US
Mailing Address - Phone:610-525-1422
Mailing Address - Fax:
Practice Address - Street 1:21 OLD OAKS RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1024
Practice Address - Country:US
Practice Address - Phone:610-324-9398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLD OAKS PROFESSIONAL SERVICES CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-28
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty