Healthcare Provider Details

I. General information

NPI: 1700262433
Provider Name (Legal Business Name): FAVOR NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 COX RD
GASTONIA NC
28054-0639
US

IV. Provider business mailing address

PO BOX 1752
GASTONIA NC
28053-1752
US

V. Phone/Fax

Practice location:
  • Phone: 704-691-3055
  • Fax:
Mailing address:
  • Phone: 704-691-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberL004135
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberL004135
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberL004135
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL004135
License Number StateNC

VIII. Authorized Official

Name: MS. MERCY AREMU
Title or Position: OWNER
Credential: RD, LDN
Phone: 704-691-3055