Provider Demographics
NPI:1609359082
Name:DEWELL, ANTONELLA (MS, RDN)
Entity Type:Individual
Prefix:
First Name:ANTONELLA
Middle Name:
Last Name:DEWELL
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 BLACKBURN ST APT A
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4925
Mailing Address - Country:US
Mailing Address - Phone:408-455-3710
Mailing Address - Fax:
Practice Address - Street 1:207 BLACKBURN ST APT A
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4925
Practice Address - Country:US
Practice Address - Phone:408-455-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty