Provider Demographics
NPI:1316274368
Name:KEHRET, MAXINE K (RD,LD)
Entity type:Individual
Prefix:MRS
First Name:MAXINE
Middle Name:K
Last Name:KEHRET
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 1ST ST E
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-3155
Mailing Address - Country:US
Mailing Address - Phone:319-332-0930
Mailing Address - Fax:
Practice Address - Street 1:1600 1ST ST E
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-3155
Practice Address - Country:US
Practice Address - Phone:319-332-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00167133V00000X
469950 ADA NUMBER133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered