Provider Demographics
NPI:1760149827
Name:KIWELL NUTRITION CONSULTING, LLC
Entity Type:Organization
Organization Name:KIWELL NUTRITION CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:RAFFETY
Authorized Official - Last Name:KENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:641-990-8910
Mailing Address - Street 1:1721 N PHILIP ST APT A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-3160
Mailing Address - Country:US
Mailing Address - Phone:641-990-8910
Mailing Address - Fax:
Practice Address - Street 1:1721 N PHILIP ST APT A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-3160
Practice Address - Country:US
Practice Address - Phone:641-990-8910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty