Healthcare Provider Details

I. General information

NPI: 1962822056
Provider Name (Legal Business Name): SUPPLEMENT YOU INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 CANAL RD
WOMELSDORF PA
19567-9124
US

IV. Provider business mailing address

844 CANAL RD
WOMELSDORF PA
19567-9124
US

V. Phone/Fax

Practice location:
  • Phone: 610-451-1787
  • Fax: 610-589-4619
Mailing address:
  • Phone: 610-451-1787
  • Fax: 610-589-4619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberRN601310
License Number StatePA

VIII. Authorized Official

Name: MRS. TRISTA MICHELLE GRAY
Title or Position: OWNER/PRACTITIONER
Credential: RN
Phone: 610-451-1787