Provider Demographics
NPI:1376129593
Name:NOURISH - BODY AND MIND, LLC
Entity Type:Organization
Organization Name:NOURISH - BODY AND MIND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:MARION
Authorized Official - Last Name:VARHOL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LDN
Authorized Official - Phone:908-892-1747
Mailing Address - Street 1:95072 WINDFLOWER TRL
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3798
Mailing Address - Country:US
Mailing Address - Phone:908-892-1747
Mailing Address - Fax:
Practice Address - Street 1:95072 WINDFLOWER TRL
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3798
Practice Address - Country:US
Practice Address - Phone:908-892-1747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty