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General NPI Number Information
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NPI Number | 1912382938
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Entity Type | Organization
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Legal Business Name | NOURISH COACHES
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 252 MAPLE AVE WIKOFF BUILDING
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City | RED BANK
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State | NJ
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Zip | 07701-1731
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Country | US
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Telephone | 732-945-9915
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Fax |
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Provider Business Mailing Address
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Address Line | 252 MAPLE AVE WIKOFF BUILDING
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City | RED BANK
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State | NJ
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Zip | 07701-1731
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Country | US
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Telephone | 732-945-9915
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEBBIE PETERSON
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Credential | CHC
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Telephone | 732-945-9915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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