Provider Demographics
NPI:1821859893
Name:TRELLES, KELLI A (NUTRITIONIST)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:A
Last Name:TRELLES
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 RIVER ST APT 266
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6462
Mailing Address - Country:US
Mailing Address - Phone:201-543-9648
Mailing Address - Fax:
Practice Address - Street 1:160 RIVER ST APT 266
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6462
Practice Address - Country:US
Practice Address - Phone:201-543-9648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist