Healthcare Provider Details

I. General information

NPI: 1033887526
Provider Name (Legal Business Name): IF I KNEW THEN WHAT I KNOW NOW NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6518 QUEENS MIDTOWN EXPY APT 1
MASPETH NY
11378-2460
US

IV. Provider business mailing address

6518 QUEENS MIDTOWN EXPY APT 1
MASPETH NY
11378-2460
US

V. Phone/Fax

Practice location:
  • Phone: 619-301-0884
  • Fax:
Mailing address:
  • Phone: 619-301-0884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: MS. TRACEY ABBAN NKRUMAH
Title or Position: CEO
Credential: RDN, CDN
Phone: 619-301-0884