Provider Demographics
NPI:1962549170
Name:KEISER, JUDITH (RD)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:KEISER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 462
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0462
Mailing Address - Country:US
Mailing Address - Phone:509-458-5800
Mailing Address - Fax:509-473-4916
Practice Address - Street 1:105 W 5TH AVE
Practice Address - Street 2:SUITE 660E
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-4820
Practice Address - Country:US
Practice Address - Phone:509-474-5445
Practice Address - Fax:509-474-2441
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000720133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8510125Medicaid
G8873605Medicare PIN
WA8510125Medicaid
WAG8893458Medicare PIN