Provider Demographics
NPI:1306230750
Name:BEWELL ASSOCIATES
Entity type:Organization
Organization Name:BEWELL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NUTRITIONISTS
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTAG
Authorized Official - Suffix:
Authorized Official - Credentials:CN
Authorized Official - Phone:814-234-0785
Mailing Address - Street 1:233 EASTERLY PKWY
Mailing Address - Street 2:104
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-6300
Mailing Address - Country:US
Mailing Address - Phone:814-234-0785
Mailing Address - Fax:814-234-0775
Practice Address - Street 1:233 EASTERLY PKWY
Practice Address - Street 2:104
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-6300
Practice Address - Country:US
Practice Address - Phone:814-234-0785
Practice Address - Fax:814-234-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty