Provider Demographics
NPI:1154078475
Name:YOUR HEALTH NUTRITION
Entity Type:Organization
Organization Name:YOUR HEALTH NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:EULISS
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:301-412-1307
Mailing Address - Street 1:7109 LIMESTONE LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-7534
Mailing Address - Country:US
Mailing Address - Phone:301-412-1307
Mailing Address - Fax:
Practice Address - Street 1:4907 NIAGARA RD STE 102
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1100
Practice Address - Country:US
Practice Address - Phone:240-215-3653
Practice Address - Fax:888-388-2830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty