1730349150 NPI number — HARRISONBURG DIETITIANS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730349150 NPI number — HARRISONBURG DIETITIANS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARRISONBURG DIETITIANS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730349150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2040 DEYERLE AVE
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
HARRISONBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22801-3582
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-437-9575
Provider Business Mailing Address Fax Number:
540-437-9576

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2040 DEYERLE AVE
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
HARRISONBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22801-3582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-437-9575
Provider Business Practice Location Address Fax Number:
540-437-9576
Provider Enumeration Date:
06/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WIENSCH-THURNAU
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
DIETITIAN MANAGER
Authorized Official Telephone Number:
540-437-9575

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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