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General NPI Number Information
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NPI Number | 1245688118
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Entity Type | Organization
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Legal Business Name | RESTORING HEALTH NUTRITION
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Dates
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Enumeration Date | 06/01/2016
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 11220 ELM LN STE 200
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City | CHARLOTTE
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State | NC
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Zip | 28277-0450
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Country | US
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Telephone | 302-632-5260
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Fax |
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Provider Business Mailing Address
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Address Line | 11220 ELM LN STE 200
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City | CHARLOTTE
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State | NC
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Zip | 28277-0450
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Country | US
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Telephone | 302-632-5260
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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 | MISS ABIADE OGUNSOLA
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Credential | R.D, CDCES
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Telephone | 302-632-5260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 00997559
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License Number State | NJ
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