Provider Demographics
NPI:1083041149
Name:NUTRAWELLNESS WORKS, INC
Entity Type:Organization
Organization Name:NUTRAWELLNESS WORKS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON-O'DELL
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:907-699-7799
Mailing Address - Street 1:1400 BLACKBERRY DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712-1810
Mailing Address - Country:US
Mailing Address - Phone:907-699-7799
Mailing Address - Fax:907-459-8201
Practice Address - Street 1:1400 BLACKBERRY DR
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99712-1810
Practice Address - Country:US
Practice Address - Phone:907-699-7799
Practice Address - Fax:907-459-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK163133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty