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General NPI Number Information
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NPI Number | 1407724404
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Entity Type | Organization
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Legal Business Name | NOURISH WELL INTEGRATIVE NUTRITION, LLC
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Dates
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Enumeration Date | 10/29/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 481 CARLISLE DR # D1
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City | HERNDON
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State | VA
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Zip | 20170-4882
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Country | US
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Telephone | 703-468-1241
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Fax | 703-468-1241
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Provider Business Mailing Address
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Address Line | 481 CARLISLE DR # D1
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City | HERNDON
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State | VA
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Zip | 20170-4882
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Country | US
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Telephone | 703-468-1241
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Fax | 703-468-1241
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Authorized Official
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Title or Position | MANAGING MEMBER/ CLINICAL DIRECTOR
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Name | DR. KEREN E DOLAN
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Credential | DCN, CNS, LDN
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Telephone | 703-468-1241
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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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