Healthcare Provider Details

I. General information

NPI: 1306230750
Provider Name (Legal Business Name): BEWELL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 EASTERLY PKWY 104
STATE COLLEGE PA
16801-6300
US

IV. Provider business mailing address

233 EASTERLY PKWY 104
STATE COLLEGE PA
16801-6300
US

V. Phone/Fax

Practice location:
  • Phone: 814-234-0785
  • Fax: 814-234-0775
Mailing address:
  • Phone: 814-234-0785
  • Fax: 814-234-0775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: MONICA MONTAG
Title or Position: CERTIFIED NUTRITIONISTS
Credential: CN
Phone: 814-234-0785