MEDICARE: VIBRANT HEALTH NUTRITION CONSULTING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist
2	133V00000X	Registered Dietitian

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528736493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIBRANT HEALTH NUTRITION CONSULTING, LLC

Provider Business Mailing Address
First Line	:	2583 CAMINO SAN PATRICIO
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-5836
Country	:	US
Telephone Number	:	505-395-0416
Fax Number	:

Provider Business Practice Location Address
First Line	:	2583 CAMINO SAN PATRICIO
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-5836
Country	:	US
Telephone Number	:	505-395-0416
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MEGAN MCNEIL
Credential	:	MS, RD, LD
Telephone Number	:	510-246-1881

Provider Enumeration Date	:	09/03/2021
Last Update Date	:	09/04/2021

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