Provider Demographics
NPI:1548599087
Name:ABREA NUTRITION INC
Entity Type:Organization
Organization Name:ABREA NUTRITION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALIZABETH
Authorized Official - Middle Name:GRACE-NEU
Authorized Official - Last Name:VAN WIEREN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:336-692-3045
Mailing Address - Street 1:181 E 6TH ST STE 509
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2971
Mailing Address - Country:US
Mailing Address - Phone:336-692-3045
Mailing Address - Fax:866-379-2713
Practice Address - Street 1:181 E 6TH ST STE 509
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2971
Practice Address - Country:US
Practice Address - Phone:336-692-3045
Practice Address - Fax:866-379-2713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003456133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty