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General NPI Number Information
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NPI Number | 1386973816
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Entity Type | Organization
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Legal Business Name | NUTRITION AND YOUR TEMPLE, LLC
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Dates
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Enumeration Date | 12/11/2009
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Last Update Date | 12/11/2009
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Provider Practice Location Address
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Address Line | 2814 WOODWAY PLACE
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City | CHEVERLY
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State | MD
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Zip | 20785-3170
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Country | US
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Telephone | 301-773-2119
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Fax |
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Provider Business Mailing Address
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Address Line | 2814 WOODWAY PLACE
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City | CHEVERLY
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State | MD
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Zip | 20785-3170
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Country | US
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Telephone | 301-773-2119
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | MS. PATRICIA NAOMI WHITE
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Credential | NUTRITIONIST
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Telephone | 301-773-2119
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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 | DX3002
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License Number State | MD
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