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General NPI Number Information
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NPI Number | 1093432841
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Entity Type | Organization
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Legal Business Name | MIND BELLY SOUL NUTRITION LLC
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 1807 WATERLOO ST
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City | PHILADELPHIA
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State | PA
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Zip | 19122-2422
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Country | US
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Telephone | 678-656-5830
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Fax |
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Provider Business Mailing Address
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Address Line | 1807 WATERLOO ST
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City | PHILADELPHIA
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State | PA
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Zip | 19122-2422
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Country | US
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Telephone | 678-656-5830
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | HANNAH PFOHL
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Credential | MS, RD, LDN
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Telephone | 678-656-5830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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