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General NPI Number Information
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NPI Number | 1760850390
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Entity Type | Organization
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Legal Business Name | MCDONOUGH NUTRITIONAL SERVICES
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Dates
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Enumeration Date | 09/14/2015
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Last Update Date | 09/14/2015
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Provider Practice Location Address
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Address Line | 6827 4TH ST NW #104
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City | WASHINGTON
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State | DC
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Zip | 20012-1900
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Country | US
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Telephone | 202-509-6991
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Fax |
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Provider Business Mailing Address
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Address Line | 6827 4TH ST NW #104
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City | WASHINGTON
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State | DC
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Zip | 20012-1900
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Country | US
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Telephone | 202-509-6991
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Fax |
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Authorized Official
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Title or Position | NUTRITIONIST
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Name | MRS. LIBIA MCDONOUGH
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Credential | MS LC
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Telephone | 202-509-6991
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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 | NU89
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License Number State | DC
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