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General NPI Number Information
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NPI Number | 1366769028
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Entity Type | Organization
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Legal Business Name | THE NUTRITION FAIRY LLC
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Dates
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Enumeration Date | 04/21/2010
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Last Update Date | 04/21/2010
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Provider Practice Location Address
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Address Line | 1813 ARLENE DR
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City | WILMINGTON
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State | DE
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Zip | 19804-4001
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Country | US
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Telephone | 302-999-0814
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Fax | 302-999-0692
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Provider Business Mailing Address
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Address Line | 1813 ARLENE DR
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City | WILMINGTON
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State | DE
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Zip | 19804-4001
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Country | US
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Telephone | 302-999-0814
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Fax | 302-999-0692
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. RAELEENA COLLINGTON
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Credential | MS LDN
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Telephone | 302-252-7688
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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 | DE0000409
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License Number State | DE
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