Healthcare Provider Details

I. General information

NPI: 1396227708
Provider Name (Legal Business Name): INSPIRED NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4729 SE GLENRIDGE TRL
STUART FL
34997-2548
US

IV. Provider business mailing address

4729 SE GLENRIDGE TRL
STUART FL
34997-2548
US

V. Phone/Fax

Practice location:
  • Phone: 973-557-8135
  • Fax:
Mailing address:
  • Phone: 973-557-8135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number8794
License Number StateFL

VIII. Authorized Official

Name: RACHEL BOSCO
Title or Position: REGISTERED DIETITIAN NUTRITIONIST
Credential: RDN, CSO, LDN
Phone: 973-557-8135