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General NPI Number Information
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NPI Number | 1265078950
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Entity Type | Organization
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Legal Business Name | ADVANCED NUTRITION SOLUTIONS
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Dates
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Enumeration Date | 11/18/2019
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Last Update Date | 11/18/2019
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Provider Practice Location Address
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Address Line | 213 STEWART ACRES
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City | WINFIELD
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State | WV
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Zip | 25213-9716
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Country | US
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Telephone | 304-951-7030
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Fax |
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Provider Business Mailing Address
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Address Line | 213 STEWART ACRES
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City | WINFIELD
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State | WV
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Zip | 25213-9716
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Country | US
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Telephone | 304-951-7030
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DUSTIN LOWELL HOLSTON
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Credential |
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Telephone | 304-951-7030
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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 |
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License Number State |
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