Provider Demographics
NPI:1063856813
Name:VIBRANT NUTRITION & WELLNESS, LLC
Entity Type:Organization
Organization Name:VIBRANT NUTRITION & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:732-829-5146
Mailing Address - Street 1:202 HEATH RD
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-2109
Mailing Address - Country:US
Mailing Address - Phone:732-829-5146
Mailing Address - Fax:908-996-2282
Practice Address - Street 1:202 HEATH RD
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-2109
Practice Address - Country:US
Practice Address - Phone:732-829-5146
Practice Address - Fax:908-996-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ916310174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty