Basic Information
| Provider Information | |||||||||
| NPI: | 1871114116 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLER | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | HELEN | ||||||||
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| Credential: | RDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1633 COVE RD | ||||||||
| Address2: | |||||||||
| City: | STURGEON BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 542351042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083692812 | ||||||||
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| Practice Location | |||||||||
| Address1: | 323 S 18TH AVE | ||||||||
| Address2: | |||||||||
| City: | STURGEON BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 542351401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9207460510 | ||||||||
| FaxNumber: | 9207463534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2020 | ||||||||
| LastUpdateDate: | 04/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 3518-29 | WI | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.