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General NPI Number Information
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NPI Number | 1609267020
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Entity Type | Organization
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Legal Business Name | BE HEALTHY BY NATURE
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Dates
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Enumeration Date | 02/06/2015
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Last Update Date | 02/06/2015
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Provider Practice Location Address
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Address Line | 9701 APOLLO DR STE 301
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City | LARGO
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State | MD
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Zip | 20774-4790
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Country | US
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Telephone | 240-334-6171
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Fax | 240-334-4848
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Provider Business Mailing Address
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Address Line | 9701 APOLLO DR STE 301
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City | LARGO
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State | MD
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Zip | 20774-4790
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Country | US
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Telephone | 240-334-6171
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Fax | 240-334-4848
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Authorized Official
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Title or Position | LICENSED DIETICIAN/NUTRITIONIST
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Name | CYNTHIA JOHNSON
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Credential | DRPH, MS, LDN
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Telephone | 240-334-6172
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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 | DX3170
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License Number State | MD
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