Provider Demographics
NPI:1144817321
Name:DETWEILER, NOAH (NHP)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:DETWEILER
Suffix:
Gender:M
Credentials:NHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3243 BRICK CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:PA
Mailing Address - Zip Code:16111-3520
Mailing Address - Country:US
Mailing Address - Phone:814-282-7404
Mailing Address - Fax:
Practice Address - Street 1:3243 BRICK CHURCH RD
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:PA
Practice Address - Zip Code:16111-3520
Practice Address - Country:US
Practice Address - Phone:814-282-7404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist