MEDICARE: NEOV 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	133VN1101X	Gerontological Nutrition Registered Dietitian

General Provider Information

NPI Number	:	1588497127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEOV NUTRITION LLC

Provider Business Mailing Address
First Line	:	2810 LEE OAKS PL UNIT 201
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-7343
Country	:	US
Telephone Number	:	703-895-2448
Fax Number	:

Provider Business Practice Location Address
First Line	:	2810 LEE OAKS PL UNIT 201
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-7343
Country	:	US
Telephone Number	:	703-895-2448
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED DIETITIAN OWNER
Name	:	MRS. ALISON NEOV
Credential	:	RD, CSG
Telephone Number	:	703-895-2448

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	08/20/2024

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