MEDICARE: HEART N SOUL NUTRITION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1497487649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART N SOUL NUTRITION LLC

Provider Business Mailing Address
First Line	:	229 BALANCE MEETING RD
Second Line	:
City	:	PEACH BOTTOM
State	:	PA
Zip	:	17563-9772
Country	:	US
Telephone Number	:	717-723-9050
Fax Number	:

Provider Business Practice Location Address
First Line	:	229 BALANCE MEETING RD
Second Line	:
City	:	PEACH BOTTOM
State	:	PA
Zip	:	17563-9772
Country	:	US
Telephone Number	:	856-270-8521
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED DIETITIAN/ OWNER
Name	:	AMANDA DAWSON
Credential	:	MS, RD, LDN
Telephone Number	:	717-723-9050

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	12/09/2024

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