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General NPI Number Information
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NPI Number | 1912482076
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Entity Type | Organization
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Legal Business Name | LOVELIFE NUTRITION AND WELLNESS
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Dates
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Enumeration Date | 09/25/2018
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 1712 TULIP ST
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City | PHILADELPHIA
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State | PA
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Zip | 19125-2427
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Country | US
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Telephone | 484-280-9239
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Fax | 267-573-3071
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Provider Business Mailing Address
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Address Line | 1712 TULIP ST
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City | PHILADELPHIA
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State | PA
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Zip | 19125-2427
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Country | US
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Telephone | 484-280-9239
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Fax | 267-573-3071
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Authorized Official
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Title or Position | OWNER
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Name | MS. VERONICA BERSANI
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Credential | MPH,RDN,LDN
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Telephone | 267-939-4349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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