Healthcare Provider Details

I. General information

NPI: 1023448974
Provider Name (Legal Business Name): KIERSTEN WEBER CNN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2013
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRANKLIN AVE
OAKLAND NJ
07436-3406
US

IV. Provider business mailing address

55 FRANKLIN AVE
OAKLAND NJ
07436
US

V. Phone/Fax

Practice location:
  • Phone: 201-446-9218
  • Fax:
Mailing address:
  • Phone: 201-446-9218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: