Healthcare Provider Details

I. General information

NPI: 1013455641
Provider Name (Legal Business Name): BERNADINE PETERS NUTRITIONISTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 DR MARTIN L KING JR AVE
MOBILE AL
36603-5341
US

IV. Provider business mailing address

1303 DR MARTIN L KING JR AVE
MOBILE AL
36603-5341
US

V. Phone/Fax

Practice location:
  • Phone: 251-436-7751
  • Fax: 251-436-7765
Mailing address:
  • Phone: 251-436-7754
  • Fax: 251-436-7765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: