MEDICARE: NUTRITION FOR A LIFETIME

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1932634557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUTRITION FOR A LIFETIME

Provider Business Mailing Address
First Line	:	2501 WINDY RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-1532
Country	:	US
Telephone Number	:	757-288-2195
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 WINDY RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-1532
Country	:	US
Telephone Number	:	757-288-2195
Fax Number	:

Authorized Official
Title or Position	:	OWNER, CEO
Name	:	MR. CATHERINE BOWERS
Credential	:	RD
Telephone Number	:	757-288-2195

Provider Enumeration Date	:	04/21/2017
Last Update Date	:	04/21/2017

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