Provider Demographics
NPI:1275043275
Name:KELLER, EMILY (RD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:KELLER
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 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 WASHINGTON STREET
Practice Address - Street 2:LEARNING INSTITUTE
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-1675
Practice Address - Country:US
Practice Address - Phone:717-221-6258
Practice Address - Fax:717-221-6266
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006360133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered