=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780328476
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NUTRITION PLUS MORE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2022
-----------------------------------------------------
Last Update Date | 06/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4403 MARKSTONE RIDGE LN
-----------------------------------------------------
City | ROSHARON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77583-1754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-377-6228
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4403 MARKSTONE RIDGE LN
-----------------------------------------------------
City | ROSHARON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77583-1754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-661-7778
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. JIE LIU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 979-661-7778
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------