Healthcare Provider Details

I. General information

NPI: 1679838585
Provider Name (Legal Business Name): CR NUTRITION AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 BALTIMORE PIKE SUITE 113A
CHADDS FORD PA
19317-7361
US

IV. Provider business mailing address

715 NORTHBROOK RD
KENNETT SQUARE PA
19348-1509
US

V. Phone/Fax

Practice location:
  • Phone: 484-467-4538
  • Fax: 610-444-0689
Mailing address:
  • Phone: 484-456-4538
  • Fax: 610-444-0689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StatePA

VIII. Authorized Official

Name: MS. CARMEL RICKENBACH
Title or Position: OWNER / MANAGER
Credential: MS, RD, LDN
Phone: 484-467-4538