Healthcare Provider Details

I. General information

NPI: 1871320705
Provider Name (Legal Business Name): INTEGRATIVE NUTRITION AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2908 SCUPPERNONG LN
DURHAM NC
27703-9263
US

IV. Provider business mailing address

2908 SCUPPERNONG LN
DURHAM NC
27703-9263
US

V. Phone/Fax

Practice location:
  • Phone: 919-907-0995
  • Fax:
Mailing address:
  • Phone: 919-793-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: BRANDI CROSSON
Title or Position: OWNER
Credential: MS, RD, LDN
Phone: 919-793-8994