MEDICARE: WELLNESS NUTRITION CONCEPTS, 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	133V00000X	Registered Dietitian	DN004868	PA

General Provider Information

NPI Number	:	1891032363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS NUTRITION CONCEPTS, LLC

Provider Business Mailing Address
First Line	:	2154 FERNCROFT LN
Second Line	:
City	:	CHESTER SPRINGS
State	:	PA
Zip	:	19425-3846
Country	:	US
Telephone Number	:	267-918-3125
Fax Number	:

Provider Business Practice Location Address
First Line	:	2154 FERNCROFT LN
Second Line	:
City	:	CHESTER SPRINGS
State	:	PA
Zip	:	19425-3846
Country	:	US
Telephone Number	:	267-918-3125
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ASHVINI MASHRU
Credential	:	RD
Telephone Number	:	267-918-3125

Provider Enumeration Date	:	01/03/2013
Last Update Date	:	01/28/2013

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