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General NPI Number Information
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NPI Number | 1316562861
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Entity Type | Organization
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Legal Business Name | KNOWINGLY NOURISHED, LLC
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Dates
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Enumeration Date | 06/10/2020
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Last Update Date | 06/10/2020
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Provider Practice Location Address
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Address Line | 6642 S LAKE SHORE DR # DI
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City | HARBOR SPRINGS
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State | MI
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Zip | 49740-9785
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Country | US
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Telephone | 231-881-6497
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Fax | 231-344-6033
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Provider Business Mailing Address
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Address Line | 6642 S LAKE SHORE DR
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City | HARBOR SPRINGS
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State | MI
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Zip | 49740-9785
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Country | US
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Telephone | 231-881-6497
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Fax | 231-344-6033
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Authorized Official
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Title or Position | OWNER
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Name | MS. NINA FEARON
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Credential | RDN
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Telephone | 231-881-6497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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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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