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General NPI Number Information
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NPI Number | 1679389654
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Entity Type | Organization
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Legal Business Name | BLOSSOM NUTRITION LLC
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 909 N AVALON ST
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City | MEMPHIS
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State | TN
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Zip | 38107-5008
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Country | US
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Telephone | 901-288-5875
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Fax |
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Provider Business Mailing Address
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Address Line | 909 N AVALON ST
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City | MEMPHIS
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State | TN
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Zip | 38107-5008
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Country | US
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Telephone | 901-288-5875
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Fax |
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Authorized Official
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Title or Position | DIETITIAN
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Name | MARGARET HERIN
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Credential | RD
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Telephone | 901-288-5875
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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 |
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License Number State |
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