Healthcare Provider Details

I. General information

NPI: 1124576509
Provider Name (Legal Business Name): REDEEMING WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 HORSESHOE TRL
DALLAS TX
75209-3324
US

IV. Provider business mailing address

5002 HORSESHOE TRL
DALLAS TX
75209-3324
US

V. Phone/Fax

Practice location:
  • Phone: 214-360-0600
  • Fax:
Mailing address:
  • Phone: 214-360-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number00001486
License Number StateWA

VIII. Authorized Official

Name: MRS. LESLIE P BUMPAS
Title or Position: OWNER
Credential: NTP
Phone: 214-360-0600