Healthcare Provider Details

I. General information

NPI: 1619654365
Provider Name (Legal Business Name): NL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7715 JOHANNA PARK DR
HOUSTON TX
77055-2095
US

IV. Provider business mailing address

7715 JOHANNA PARK DR
HOUSTON TX
77055-2095
US

V. Phone/Fax

Practice location:
  • Phone: 713-208-0152
  • Fax:
Mailing address:
  • Phone: 713-208-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: NGAN T LY
Title or Position: REGISTERED DIETITIAN
Credential: RDN
Phone: 713-208-0152