Healthcare Provider Details

I. General information

NPI: 1841188661
Provider Name (Legal Business Name): HEALTHFUL NUTRITION & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 LYNCH CREEK WAY
PETALUMA CA
94954-2342
US

IV. Provider business mailing address

1417 SIERRA DR
PETALUMA CA
94954-3717
US

V. Phone/Fax

Practice location:
  • Phone: 707-364-3527
  • Fax:
Mailing address:
  • Phone: 707-364-3527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: HEATHER TASSELMYER
Title or Position: DIETITIAN/OWNER
Credential: RD
Phone: 707-364-3527