Provider Demographics
NPI:1902226723
Name:KEYES, JEANETTE (JAN) (CNC)
Entity Type:Individual
Prefix:
First Name:JEANETTE (JAN)
Middle Name:
Last Name:KEYES
Suffix:
Gender:F
Credentials:CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 BEACON HILL RD
Mailing Address - Street 2:
Mailing Address - City:CALIFON
Mailing Address - State:NJ
Mailing Address - Zip Code:07830-3519
Mailing Address - Country:US
Mailing Address - Phone:908-832-9690
Mailing Address - Fax:
Practice Address - Street 1:216 BEACON HILL RD
Practice Address - Street 2:
Practice Address - City:CALIFON
Practice Address - State:NJ
Practice Address - Zip Code:07830-3519
Practice Address - Country:US
Practice Address - Phone:908-832-9690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-19
Last Update Date:2014-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist