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General NPI Number Information
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NPI Number | 1922344456
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Entity Type | Organization
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Legal Business Name | MAGNIFICAT NUTRITION SERVICES, INC.
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Dates
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Enumeration Date | 01/03/2013
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Last Update Date | 01/03/2013
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Provider Practice Location Address
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Address Line | 9108 LYON PARK COURT
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City | BURKE
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State | VA
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Zip | 22015
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Country | US
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Telephone | 703-978-5346
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Fax |
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Provider Business Mailing Address
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Address Line | 9108 LYON PARK COURT
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City | BURKE
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State | VA
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Zip | 22015
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Country | US
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Telephone | 703-978-5346
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. GRACE T NERIA
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Credential | M.S., R.D., L.D.
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Telephone | 703-978-5346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | D00985
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | D00985
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DI221
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License Number State | DC
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