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General NPI Number Information
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NPI Number | 1255773636
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Entity Type | Organization
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Legal Business Name | NOURISH & RENEW
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 8 HEBRON ROAD, 2ND FLOOR ONEIDA HOLISTIC HEALTH CENTER
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City | MARLBOROUGH
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State | CT
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Zip | 06447-1272
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Country | US
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Telephone | 860-467-6518
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Fax |
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Provider Business Mailing Address
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Address Line | 549 E CENTER ST
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City | MANCHESTER
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State | CT
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Zip | 06040-4441
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Country | US
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Telephone | 860-997-7900
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ANITA SCHUBERT
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Credential | M.S.
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Telephone | 860-997-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 001160
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License Number State | CT
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