Physician Compare National (NPI:1043582026)

HEALTHCARE PROVIDER: LELLIETH KEIZE REGISTERED DIETITIAN

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1043582026
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4587928296
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200403001048
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	LATCHMAN
	Individual professional last name
Provider First Name	LELLIETH
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2009
	Individual professional's medical school graduation year
Primary Specialty	REGISTERED DIETITIAN OR NUTRITION PROFESSIONAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	101 MERRITT
	Group Practice or individual's line 1 address
Line 2 Street Address	7 SUITE 300
	Group Practice or individual's line 2 address
City	NORWALK
	Group Practice or individual's city
State	CT
	Group Practice or individual's state
Zip Code	068511059
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4758897953
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	070034
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NORWALK HOSPITAL ASSOCIATION
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	M