Healthcare Provider Details

I. General information

NPI: 1962906008
Provider Name (Legal Business Name): HEALTH OPERA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LIBERTY DRIVE
MADISON AL
35758-8384
US

IV. Provider business mailing address

P.O. BOX 1471
MADISON AL
35758-8384
US

V. Phone/Fax

Practice location:
  • Phone: 256-721-4063
  • Fax: 256-721-4063
Mailing address:
  • Phone: 256-721-4063
  • Fax: 256-721-4063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1396
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1396
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number712484
License Number StateIL

VIII. Authorized Official

Name: MS. DONNA SMITH
Title or Position: PRESIDENT
Credential: RDN LDN
Phone: 256-721-4063