Organization
INDIGENOUS NUTRITIONIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY JACQUELINE AHEARN RDN (OWNER)
(207) 344-7115
Entity
Organization
Contact information
Practice address
538 E 85TH ST, 5B, NEW YORK, NY 10028-7447
(207) 344-7115
Mailing address
538 E 85TH ST, 5B, NEW YORK, NY 10028-7447
(207) 344-7115
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
48007672
NY
Other
Enumeration date
09/14/2015
Last updated
09/14/2015
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