Healthcare Provider Details

I. General information

NPI: 1134459803
Provider Name (Legal Business Name): NICOLE LEFEVER KEEVER MS, RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2010
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W MAIN ST UNIT G2
SALUNGA PA
17538-1109
US

IV. Provider business mailing address

101 W MAIN ST UNIT G2
SALUNGA PA
17538-1109
US

V. Phone/Fax

Practice location:
  • Phone: 717-320-4421
  • Fax: 717-618-8376
Mailing address:
  • Phone: 717-320-4421
  • Fax: 717-618-8376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN004312
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: