Healthcare Provider Details

I. General information

NPI: 1043178627
Provider Name (Legal Business Name): NUTRITION A LA VICTOIRE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E BLAND ST UNIT 363
CHARLOTTE NC
28203-6183
US

IV. Provider business mailing address

222 E BLAND ST UNIT 363
CHARLOTTE NC
28203-6183
US

V. Phone/Fax

Practice location:
  • Phone: 704-559-9889
  • Fax:
Mailing address:
  • Phone: 704-559-9889
  • 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: VICTOIRE OMOU
Title or Position: OWNER, LEAD DIETITIAN
Credential: MS, RDN
Phone: 704-559-9889