Healthcare Provider Details

I. General information

NPI: 1255773636
Provider Name (Legal Business Name): NOURISH & RENEW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 HEBRON ROAD, 2ND FLOOR ONEIDA HOLISTIC HEALTH CENTER
MARLBOROUGH CT
06447-1272
US

IV. Provider business mailing address

549 E CENTER ST
MANCHESTER CT
06040-4441
US

V. Phone/Fax

Practice location:
  • Phone: 860-467-6518
  • Fax:
Mailing address:
  • Phone: 860-997-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number001160
License Number StateCT

VIII. Authorized Official

Name: MS. ANITA SCHUBERT
Title or Position: OWNER
Credential: M.S.
Phone: 860-997-7900