Healthcare Provider Details

I. General information

NPI: 1033931654
Provider Name (Legal Business Name): NOURISH WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N VINEYARD BLVD STE A325 #1122
HONOLULU HI
96817
US

IV. Provider business mailing address

200 N VINEYARD BLVD STE A325 #1122
HONOLULU HI
96817
US

V. Phone/Fax

Practice location:
  • Phone: 646-400-8723
  • Fax: 808-663-0321
Mailing address:
  • Phone: 646-400-8723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA BECKER
Title or Position: OWNER
Credential: RD, MPH, NBC-HWC
Phone: 646-400-8723