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1043582026 NPI number — LELLIETH KEIZE REGISTERED DIETITIAN

NPI Number: 1043582026
Health Care Provider/Practitioner: LELLIETH KEIZE REGISTERED DIETITIAN

Information about “1043582026” NPI (LELLIETH KEIZE REGISTERED DIETITIAN) exists in 1043582026 in HTML format HTML  |  1043582026 in plain Text format TXT  |  1043582026 in PDF (Portable Document Format) PDF  |  1043582026 in an XML format XML  formats.

NPI Number : 1043582026 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043582026",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KEIZE",
    "FirstName": "LELLIETH",
    "MiddleName": null,
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "REGISTERED DIETITIAN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LATCHMAN",
    "OtherFirstName": "LELLIETH",
    "OtherMiddleName": null,
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": "MS, RDN, CDCES",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "14 FERRIS AVE APT 10",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NORWALK",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06854-1538",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "203-952-9715",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "19 OLD KINGS HWY S STE 200",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DARIEN",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06820-4532",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "203-952-3534",
    "PracticeLocationAddressFaxNumber": "203-803-4697",
    "EnumerationDate": "02/06/2012",
    "LastUpdateDate": "09/15/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "133V00000X",
        "TaxonomyName": "Registered Dietitian",
        "LicenseNumber": "965780",
        "LicenseNumberStateCode": "CT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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