Healthcare Provider Details

I. General information

NPI: 1396317806
Provider Name (Legal Business Name): ONE BITE NUTRITION CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 WESTBROOK DR
SUNRISE BEACH MO
65079-7410
US

IV. Provider business mailing address

193 WESTBROOK DR
SUNRISE BEACH MO
65079-7410
US

V. Phone/Fax

Practice location:
  • Phone: 573-836-2866
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: WENDY CASTLE
Title or Position: OWNER
Credential:
Phone: 573-836-2866