1831268242 NPI number — MRS. ROBERTA DEGROODT MEARNS RD LD CDE

Table of content: MRS. ROBERTA DEGROODT MEARNS RD LD CDE (NPI 1831268242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831268242 NPI number — MRS. ROBERTA DEGROODT MEARNS RD LD CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEARNS
Provider First Name:
ROBERTA
Provider Middle Name:
DEGROODT
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD LD CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEARNS
Provider Other First Name:
BOBBIE
Provider Other Middle Name:
DEGROODT
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD LD CDE
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1831268242
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
THE NUTRITIVE EDGE
Provider Second Line Business Mailing Address:
34 PANEPINTO DRIVE
Provider Business Mailing Address City Name:
SCHWENKSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-246-0656
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
THE NUTRITIVE EDGE
Provider Second Line Business Practice Location Address:
34 PANEPINTO DRIVE
Provider Business Practice Location Address City Name:
SCHWENKSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-246-0656
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133VN1006X , with the licence number:  DN001314 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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