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General NPI Number Information
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NPI Number | 1174376289
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Entity Type | Organization
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Legal Business Name | HONOR NUTRITION
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Dates
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Enumeration Date | 04/09/2024
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 1120 ROSEDALE BLVD APT 202
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City | LYNCHBURG
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State | VA
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Zip | 24502-4242
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Country | US
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Telephone | 434-277-1805
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Fax |
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Provider Business Mailing Address
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Address Line | 21430 TIMBERLAKE RD STE F
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City | LYNCHBURG
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State | VA
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Zip | 24502-7271
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Country | US
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Telephone | 336-624-3191
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JORDAN HARRIS
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Credential | MS,RD,CSCS
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Telephone | 336-624-3191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1501X
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Taxonomy Name | Sports Dietetics Nutrition Registered Dietitian
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License Number |
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License Number State |
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