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General NPI Number Information
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NPI Number | 1851182794
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Entity Type | Organization
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Legal Business Name | SIMPLE ROOTS NUTRITION LLC
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 03/17/2026
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Provider Practice Location Address
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Address Line | 811 WARWICK AVE APT 5L
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City | WARWICK
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State | RI
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Zip | 02888-2600
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Country | US
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Telephone | 660-281-8849
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Fax |
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Provider Business Mailing Address
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Address Line | 811 WARWICK AVE APT 5L
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City | WARWICK
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State | RI
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Zip | 02888-2600
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Country | US
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Telephone | 660-281-8849
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HOLLI MOOTZ
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Credential | RD
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Telephone | 660-281-8849
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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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