Healthcare Provider Details

I. General information

NPI: 1043671597
Provider Name (Legal Business Name): BIO WELL NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 MAIN ST SUITE 550D
VANCOUVER WA
98660-2999
US

IV. Provider business mailing address

22101 NE 99TH ST
VANCOUVER WA
98682-9785
US

V. Phone/Fax

Practice location:
  • Phone: 949-413-1422
  • Fax:
Mailing address:
  • Phone: 949-413-1422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateWA

VIII. Authorized Official

Name: DANIELE NICOLE DELLA VALLE
Title or Position: OWNER
Credential: NTP
Phone: 949-413-1422