Healthcare Provider Details

I. General information

NPI: 1073725750
Provider Name (Legal Business Name): NUTRITION MATTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4014 SOUTH MAIN STREET
TRAPPE MD
21673-0630
US

IV. Provider business mailing address

PO BOX 630 4014 MAIN STREET
TRAPPE MD
21673-0630
US

V. Phone/Fax

Practice location:
  • Phone: 410-476-9776
  • Fax: 410-476-3141
Mailing address:
  • Phone: 410-476-9776
  • Fax: 410-476-3141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD01059
License Number StateMD

VIII. Authorized Official

Name: MS. LYNNE J. HARRIS
Title or Position: OWNER
Credential: RD
Phone: 410-476-9776