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General NPI Number Information
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NPI Number | 1902329766
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Entity Type | Organization
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Legal Business Name | NOURISHED LIFESTYLES, LLC
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Dates
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Enumeration Date | 07/24/2017
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Last Update Date | 06/16/2026
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Provider Practice Location Address
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Address Line | 7 OAK HILL TER STE 215
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City | SCARBOROUGH
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State | ME
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Zip | 04074-8996
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Country | US
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Telephone | 207-835-1566
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Fax | 207-636-8107
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Provider Business Mailing Address
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Address Line | 7 OAK HILL TER STE 215
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City | SCARBOROUGH
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State | ME
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Zip | 04074-8996
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Country | US
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Telephone | 207-835-1566
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Fax | 207-636-8107
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Authorized Official
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Title or Position | PRESIDENT
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Name | LESLIE OUELLETTE-TODD
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Credential | RDN, LD
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Telephone | 207-837-4473
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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 | DI1103
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License Number State | ME
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