Healthcare Provider Details

I. General information

NPI: 1205196755
Provider Name (Legal Business Name): BLANCHE KEIR R.D., LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 LANSDOWNE AVE
HADDONFIELD NJ
08033-2735
US

IV. Provider business mailing address

111 LANSDOWNE AVE
HADDONFIELD NJ
08033-2735
US

V. Phone/Fax

Practice location:
  • Phone: 856-261-5277
  • Fax:
Mailing address:
  • Phone: 856-261-5277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberDN004653
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: