Provider Demographics
NPI:1396556288
Name:KEESLAR, CEYLON ROSE (NUTRITIONIST)
Entity type:Individual
Prefix:
First Name:CEYLON
Middle Name:ROSE
Last Name:KEESLAR
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 1:6954 GOODWIN RD
Mailing Address - Street 2:
Mailing Address - City:EVERSON
Mailing Address - State:WA
Mailing Address - Zip Code:98247-9456
Mailing Address - Country:US
Mailing Address - Phone:360-789-3978
Mailing Address - Fax:
Practice Address - Street 1:6954 GOODWIN RD
Practice Address - Street 2:
Practice Address - City:EVERSON
Practice Address - State:WA
Practice Address - Zip Code:98247-9456
Practice Address - Country:US
Practice Address - Phone:360-789-3978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist