Healthcare Provider Details

I. General information

NPI: 1164340253
Provider Name (Legal Business Name): WHOLESOME WITH EL NUTRITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8212 YELLOW SPRINGS RD
FREDERICK MD
21702-2818
US

IV. Provider business mailing address

8212 YELLOW SPRINGS RD
FREDERICK MD
21702-2818
US

V. Phone/Fax

Practice location:
  • Phone: 301-471-5588
  • Fax:
Mailing address:
  • Phone: 301-471-5588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH MARIE REYNOLDS
Title or Position: REGISTERED DIETITIAN
Credential: MS, RDN, LDN
Phone: 301-471-5588