Healthcare Provider Details

I. General information

NPI: 1881886745
Provider Name (Legal Business Name): FITNESS AND NUTRITION 101
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2253 S CHURCH ST
BURLINGTON NC
27215-5329
US

IV. Provider business mailing address

2253 S CHURCH ST
BURLINGTON NC
27215-5329
US

V. Phone/Fax

Practice location:
  • Phone: 336-222-8615
  • Fax:
Mailing address:
  • Phone: 336-222-8615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number212708
License Number StateCA

VIII. Authorized Official

Name: CARMELITA TIBURCIO BIGELOW
Title or Position: PROGRAM DIRECTOR
Credential: DT CDM
Phone: 336-222-8616