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General NPI Number Information
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NPI Number | 1053611087
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Entity Type | Individual
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Provider Name | JANINE M KILLEEN RD, CDE,CDN
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Gender | Female
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Dates
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Enumeration Date | 10/25/2010
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Last Update Date | 10/25/2010
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Provider Practice Location Address
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Address Line | 25 HIGHLAND AVE
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City | WARWICK
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State | NY
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Zip | 10990
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Country | US
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Telephone | 845-987-5197
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Fax |
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Provider Business Mailing Address
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Address Line | 25 HIGHLAND AVE
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City | WARWICK
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State | NY
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Zip | 10990
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Country | US
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Telephone | 845-987-5197
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Fax | 845-987-5277
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 004032-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 836113
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License Number State | IL
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