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General NPI Number Information
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NPI Number | 1982074761
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Entity Type | Organization
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Legal Business Name | ENVIRO-BALANCE NUTRITION,LLC
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Dates
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Enumeration Date | 10/06/2015
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Last Update Date | 10/24/2017
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Provider Practice Location Address
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Address Line | 716 S MAIN ST
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City | RUSSELL
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State | PA
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Zip | 16345-1154
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Country | US
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Telephone | 814-706-8518
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Fax |
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Provider Business Mailing Address
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Address Line | 716 S MAIN ST
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City | RUSSELL
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State | PA
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Zip | 16345-1154
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Country | US
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Telephone | 814-706-8518
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PAMELA ENGLISH
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Credential | RDN, LDN
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Telephone | 814-706-8518
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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 | DN004842
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number | DN004842
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 133VN1005X
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Taxonomy Name | Renal Nutrition Registered Dietitian
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License Number | DN004842
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | DN004842
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DN004842
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License Number State | PA
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