Healthcare Provider Details

I. General information

NPI: 1508308263
Provider Name (Legal Business Name): NUTRITION EDUCATION RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2016
Last Update Date: 11/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 RIVER OAKS DR
LA PLACE LA
70068-7100
US

IV. Provider business mailing address

112 RIVER OAKS DR
LA PLACE LA
70068-7100
US

V. Phone/Fax

Practice location:
  • Phone: 985-651-2342
  • Fax: 888-573-1919
Mailing address:
  • Phone: 985-651-2342
  • Fax: 888-573-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number1654
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1654
License Number StateLA

VIII. Authorized Official

Name: VIRGINIA JO DANTONE
Title or Position: CEO
Credential: RDN, CDE
Phone: 985-651-2342