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General NPI Number Information
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NPI Number | 1427559988
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Entity Type | Organization
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Legal Business Name | NOURISH TO REVIVE, LLC
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Dates
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Enumeration Date | 02/21/2018
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 905 W STATE ST STE B
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City | FREMONT
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State | OH
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Zip | 43420-2501
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Country | US
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Telephone | 419-603-7788
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Fax |
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Provider Business Mailing Address
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Address Line | 905 W STATE ST STE B
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City | FREMONT
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State | OH
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Zip | 43420-2501
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Country | US
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Telephone | 419-603-7788
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Fax |
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Authorized Official
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Title or Position | OWNER/ HEALTHCARE PRACTITIONER
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Name | JOYCE A KLEIN
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Credential | MFN, RDN, CLT
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Telephone | 419-603-7788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LD7029
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License Number State | OH
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