Provider Demographics
NPI:1659750479
Name:ANN KEATING INTEGRATIVE NUTRITION, LLC
Entity Type:Organization
Organization Name:ANN KEATING INTEGRATIVE NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEATING
Authorized Official - Suffix:
Authorized Official - Credentials:CNS, LDN
Authorized Official - Phone:301-704-2909
Mailing Address - Street 1:13321 DOVEDALE WAY APT G
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-4457
Mailing Address - Country:US
Mailing Address - Phone:301-704-2909
Mailing Address - Fax:
Practice Address - Street 1:10440 SHAKER DR
Practice Address - Street 2:STES 103 AND 203
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1200
Practice Address - Country:US
Practice Address - Phone:301-704-2909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3674133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty