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General NPI Number Information
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NPI Number | 1063856813
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Entity Type | Organization
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Legal Business Name | VIBRANT NUTRITION & WELLNESS, LLC
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Dates
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Enumeration Date | 04/23/2013
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Last Update Date | 05/05/2013
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Provider Practice Location Address
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Address Line | 202 HEATH RD
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City | FLEMINGTON
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State | NJ
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Zip | 08822-2109
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Country | US
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Telephone | 732-829-5146
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Fax | 908-996-2282
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Provider Business Mailing Address
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Address Line | 202 HEATH RD
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City | FLEMINGTON
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State | NJ
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Zip | 08822-2109
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Country | US
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Telephone | 732-829-5146
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Fax | 908-996-2282
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | MS. ANNETTE O'NEILL
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Credential | RD
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Telephone | 732-829-5146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 916310
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License Number State | NJ
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