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General NPI Number Information
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NPI Number | 1265155337
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Entity Type | Organization
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Legal Business Name | JUNO WELLNESS
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Dates
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Enumeration Date | 09/22/2022
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 492 ELDEN ST
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City | HERNDON
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State | VA
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Zip | 20170-4513
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Country | US
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Telephone | 703-775-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 492 ELDEN ST
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City | HERNDON
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State | VA
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Zip | 20170-4513
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Country | US
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Telephone | 703-775-4000
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Fax |
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Authorized Official
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Title or Position | NUTRITION DIRECTOR
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Name | KRISTINA PESTANA
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Credential | CNS, LDN
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Telephone | 703-775-4000
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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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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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