Provider Demographics
NPI:1093457889
Name:ILLUMINATE CULTURAL NUTRITION AND WELLNESS LLC
Entity Type:Organization
Organization Name:ILLUMINATE CULTURAL NUTRITION AND WELLNESS LLC
Other - Org Name:CNR NUTRITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLANDE
Authorized Official - Middle Name:
Authorized Official - Last Name:UNELUS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, RD, LDN, CHN
Authorized Official - Phone:973-573-8609
Mailing Address - Street 1:104 SOUTHWOLD DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-5933
Mailing Address - Country:US
Mailing Address - Phone:973-573-8609
Mailing Address - Fax:
Practice Address - Street 1:140 TOWERVIEW CT STE 102
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3595
Practice Address - Country:US
Practice Address - Phone:910-290-6479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty