Provider Demographics
NPI:1508194416
Name:NUTRITION AND YOUR TEMPLE, LLC
Entity Type:Organization
Organization Name:NUTRITION AND YOUR TEMPLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:NAOMI
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD LDN
Authorized Official - Phone:301-773-2119
Mailing Address - Street 1:2814 WOODWAY PL
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-3170
Mailing Address - Country:US
Mailing Address - Phone:301-773-2119
Mailing Address - Fax:
Practice Address - Street 1:2814 WOODWAY PL
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-3170
Practice Address - Country:US
Practice Address - Phone:301-773-2119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3002251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare