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General NPI Number Information
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NPI Number | 1740647593
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Entity Type | Individual
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Provider Name | JAN KIELMANN MS, CNS, IFMCP
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Gender | Male
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 09/19/2019
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Provider Practice Location Address
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Address Line | 112 E OLIVE AVE STE F
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City | REDLANDS
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State | CA
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Zip | 92373-5281
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Country | US
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Telephone | 909-810-0858
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Fax |
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Provider Business Mailing Address
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Address Line | 10600 HIGHLAND SPRINGS AVE
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City | CHERRY VALLEY
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State | CA
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Zip | 92223-5548
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Country | US
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Telephone |
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Fax |
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | NU 60611293
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License Number State | WA
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