Healthcare Provider Details

I. General information

NPI: 1932894342
Provider Name (Legal Business Name): RESILIENT HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 04/11/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5407 PATTERSON AVE
RICHMOND VA
23226-2040
US

IV. Provider business mailing address

4801 MORRISON RD
RICHMOND VA
23230-2504
US

V. Phone/Fax

Practice location:
  • Phone: 434-944-8475
  • Fax:
Mailing address:
  • Phone: 434-944-8475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: STEPHANNIE FRIEND
Title or Position: NUTRITIONIST
Credential: CNS
Phone: 434-944-8475