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General NPI Number Information
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NPI Number | 1043468184
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Entity Type | Organization
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Legal Business Name | ESSENTIAL NUTRITION FOR WELLNESS, LLC.
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | 1941 HAMILTON ST STE 102
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City | ALLENTOWN
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State | PA
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Zip | 18104-6470
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Country | US
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Telephone | 610-703-4502
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Fax |
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Provider Business Mailing Address
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Address Line | 2672 TOWNSHIP LINE RD
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City | OREFIELD
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State | PA
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Zip | 18069-2845
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Country | US
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Telephone | 610-703-4502
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MS. SUZANNE YOST
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Credential | RD, LDN
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Telephone | 610-703-4502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | DN001564
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | DN001564
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DN001564
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License Number State | PA
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