1235412792 NPI number — MRS. KELLI ANN SCHWARTZ MS,RD,LD

Table of content: MRS. KELLI ANN SCHWARTZ MS,RD,LD (NPI 1235412792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235412792 NPI number — MRS. KELLI ANN SCHWARTZ MS,RD,LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHWARTZ
Provider First Name:
KELLI
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS,RD,LD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAKEL
Provider Other First Name:
KELLI
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS,RD,LD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235412792
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6350 E GALBRAITH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45236-2354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-686-6820
Provider Business Mailing Address Fax Number:
513-686-6819

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6350 E GALBRAITH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45236-2354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-686-6820
Provider Business Practice Location Address Fax Number:
513-686-6819
Provider Enumeration Date:
09/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  5151 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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