Healthcare Provider Details

I. General information

NPI: 1346434305
Provider Name (Legal Business Name): NUTRITION COACHING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 LEE HWY SUITE #101
ARLINGTON VA
22207-1619
US

IV. Provider business mailing address

5275 LEE HWY SUITE #101
ARLINGTON VA
22207-1619
US

V. Phone/Fax

Practice location:
  • Phone: 703-516-4973
  • Fax: 703-358-8703
Mailing address:
  • Phone: 703-516-4973
  • Fax: 703-358-8703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. LISE ANNE GLOEDE
Title or Position: OWNER
Credential: RD, CDE
Phone: 703-516-4973