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General NPI Number Information
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NPI Number | 1376914853
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Entity Type | Organization
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Legal Business Name | NUTRITIONALLY YOURS LLC
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Dates
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Enumeration Date | 10/09/2015
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Last Update Date | 04/14/2023
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Provider Practice Location Address
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Address Line | 1112 LADOWICK LN
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City | WAKE FOREST
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State | NC
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Zip | 27587-5584
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Country | US
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Telephone | 919-426-6956
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Fax | 919-300-8913
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Provider Business Mailing Address
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Address Line | 1112 LADOWICK LN
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City | WAKE FOREST
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State | NC
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Zip | 27587-5584
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Country | US
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Telephone | 919-426-6956
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Fax | 919-930-8685
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Authorized Official
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Title or Position | OWNER
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Name | MS. MANJUSHREE KARKARE
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Credential | MS RDN LDN
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Telephone | 919-426-6956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | L001824
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License Number State | NC
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