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General NPI Number Information
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NPI Number | 1720671787
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Entity Type | Organization
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Legal Business Name | FABULOUS HEALING NUTRITION & WELLNESS LLC
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Dates
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Enumeration Date | 02/19/2021
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 11285 NW 317TH PL
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City | NORTH PLAINS
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State | OR
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Zip | 97133-6219
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Country | US
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Telephone | 503-899-8204
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Fax | 954-908-6525
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Provider Business Mailing Address
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Address Line | 11285 NW 317TH PL
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City | NORTH PLAINS
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State | OR
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Zip | 97133-6219
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Country | US
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Telephone | 503-773-9170
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Fax | 954-908-6525
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Authorized Official
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Title or Position | FOUNDER
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Name | LIAT NADLER
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Credential | MS, CNS, LD
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Telephone | 503-773-9170
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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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Taxonomy #2
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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