Provider Demographics
NPI:1811030844
Name:ZWEIFEL, KELLY KEYES (DIETITIAN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:KEYES
Last Name:ZWEIFEL
Suffix:
Gender:F
Credentials:DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 GREG KRUSCHEK AVE
Mailing Address - Street 2:
Mailing Address - City:NOME
Mailing Address - State:AK
Mailing Address - Zip Code:99762-0966
Mailing Address - Country:US
Mailing Address - Phone:907-443-3480
Mailing Address - Fax:
Practice Address - Street 1:1000 GREG KRUCHECK AVE
Practice Address - Street 2:
Practice Address - City:NOME
Practice Address - State:AK
Practice Address - Zip Code:99762-0966
Practice Address - Country:US
Practice Address - Phone:907-443-3480
Practice Address - Fax:907-443-3723
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK165133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK165OtherSTATE OF ALASKA