Provider Demographics
NPI:1376283606
Name:WHOLESOME NUTRITION LLC
Entity Type:Organization
Organization Name:WHOLESOME NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CIPRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:908-420-1856
Mailing Address - Street 1:2509 LINDSLEY RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3509
Mailing Address - Country:US
Mailing Address - Phone:908-420-1856
Mailing Address - Fax:
Practice Address - Street 1:2509 LINDSLEY RD
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3509
Practice Address - Country:US
Practice Address - Phone:908-420-1856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty