Provider Demographics
NPI:1477170785
Name:PROSPER NUTRITION AND WELLNESS
Entity Type:Organization
Organization Name:PROSPER NUTRITION AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:509-860-1051
Mailing Address - Street 1:1155 N STATE ST STE 521
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5045
Mailing Address - Country:US
Mailing Address - Phone:509-860-1051
Mailing Address - Fax:360-746-2495
Practice Address - Street 1:1155 N STATE ST STE 521
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5045
Practice Address - Country:US
Practice Address - Phone:509-860-1051
Practice Address - Fax:360-746-2495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty