MEDICARE: HOUSECALL NUTRITION OF VIRGINIA 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

General Provider Information

NPI Number	:	1902288368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSECALL NUTRITION OF VIRGINIA LLC

Provider Business Mailing Address
First Line	:	105 SEA TRACE CT
Second Line	:	APT 102
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-4448
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 SEA TRACE CT
Second Line	:	APT 102
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-4448
Country	:	US
Telephone Number	:	585-469-6227
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	THERESA M OLEKSYN
Credential	:	RDN,CNSC
Telephone Number	:	585-469-6227

Provider Enumeration Date	:	06/22/2015
Last Update Date	:	06/22/2015

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