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General NPI Number Information
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NPI Number | 1528639978
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Entity Type | Organization
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Legal Business Name | KSSENTIAL NUTRITION LLC
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Dates
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Enumeration Date | 07/07/2021
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 2802 TYBURN OAKS CT
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City | WALDORF
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State | MD
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Zip | 20601-7271
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Country | US
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Telephone | 240-460-8290
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Fax |
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Provider Business Mailing Address
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Address Line | 2802 TYBURN OAKS CT
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City | WALDORF
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State | MD
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Zip | 20601-7271
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Country | US
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Telephone | 240-460-8290
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Fax |
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Authorized Official
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Title or Position | CLINICAL NUTRITIONIST
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Name | KANWAL MANSUR
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Credential | MS,CNS,LDN,MBBS
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Telephone | 240-460-8290
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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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