Healthcare Provider Details

I. General information

NPI: 1598206567
Provider Name (Legal Business Name): KELLY KREMNITZER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2017
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2385 NW EXECUTIVE CENTER DR STE 100
BOCA RATON FL
33431-8579
US

IV. Provider business mailing address

2385 NW EXECUTIVE CENTER DR STE 100
BOCA RATON FL
33431-8579
US

V. Phone/Fax

Practice location:
  • Phone: 561-962-2719
  • Fax:
Mailing address:
  • Phone: 561-962-2719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number7335
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number7335
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: