Provider Demographics
NPI:1194398578
Name:BLISSNUTRI WELLNESS LLC
Entity Type:Organization
Organization Name:BLISSNUTRI WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDERMANN-BIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-874-9744
Mailing Address - Street 1:660 S BAGDAD RD
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-5048
Mailing Address - Country:US
Mailing Address - Phone:832-874-9744
Mailing Address - Fax:
Practice Address - Street 1:660 S BAGDAD RD
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-5048
Practice Address - Country:US
Practice Address - Phone:832-874-9744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-22
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty