Provider Demographics
NPI:1073886610
Name:NOURITION
Entity Type:Organization
Organization Name:NOURITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOUR
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZIBDEH
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:571-449-6687
Mailing Address - Street 1:13591 BATHGATE DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-3497
Mailing Address - Country:US
Mailing Address - Phone:571-449-6687
Mailing Address - Fax:
Practice Address - Street 1:13591 BATHGATE DR
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-3497
Practice Address - Country:US
Practice Address - Phone:571-449-6687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty