Provider Demographics
NPI:1861510711
Name:KEIM, NANCY J (RD)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:J
Last Name:KEIM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:LEOPOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63760-0023
Mailing Address - Country:US
Mailing Address - Phone:573-568-4593
Mailing Address - Fax:
Practice Address - Street 1:1001 NORTH HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:MO
Practice Address - Zip Code:63825-0000
Practice Address - Country:US
Practice Address - Phone:573-238-1620
Practice Address - Fax:567-568-4736
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005020910133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered