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General NPI Number Information
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NPI Number | 1447911250
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Entity Type | Organization
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Legal Business Name | MINDFUL NOURISHMENT LLC
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 2510 GREEN PINE CT
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City | WALDORF
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State | MD
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Zip | 20601-3050
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Country | US
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Telephone | 570-875-7653
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Fax |
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Provider Business Mailing Address
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Address Line | 2510 GREEN PINE CT
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City | WALDORF
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State | MD
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Zip | 20601-3050
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Country | US
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Telephone | 570-875-7653
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | MRS. FRANCES RITINSKI CLARK
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Credential | RDN, CSR, LDN
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Telephone | 570-875-7653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1005X
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Taxonomy Name | Renal Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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