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General NPI Number Information
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NPI Number | 1235009788
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Entity Type | Organization
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Legal Business Name | NOURISHED LIVING LLC
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Dates
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Enumeration Date | 11/10/2025
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 1219 E MARKET ST
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-5445
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Country | US
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Telephone | 202-460-7030
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Fax |
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Provider Business Mailing Address
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Address Line | 4445 CORPORATION LN STE 264
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-3671
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED DIETITIAN NUTRITIONIST
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Name | NIRVANA ABOU GABAL
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Credential | LDN, CNS
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Telephone | 202-460-7030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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