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General NPI Number Information
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NPI Number | 1265778187
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Entity Type | Organization
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Legal Business Name | WHOLESOME NUTRITION, LLC.
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Dates
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Enumeration Date | 12/20/2012
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Last Update Date | 12/20/2012
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Provider Practice Location Address
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Address Line | 400 HORSHAM RD
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City | HORSHAM
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State | PA
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Zip | 19044-2140
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Country | US
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Telephone | 215-675-4535
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Fax |
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Provider Business Mailing Address
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Address Line | 305 GREENHILL RD
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City | WILLOW GROVE
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State | PA
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Zip | 19090-2812
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Country | US
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Telephone | 717-576-6305
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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 | CASEY MCKINNEY
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Credential | RD, LDN, CDE
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Telephone | 717-576-6305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | DN003959
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License Number State | PA
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