Provider Demographics
NPI:1568874113
Name:NEPA NUTRITION AND PERSONAL TRAINING SERVICE LLC.
Entity Type:Organization
Organization Name:NEPA NUTRITION AND PERSONAL TRAINING SERVICE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MS RDN LDN
Authorized Official - Phone:570-687-8230
Mailing Address - Street 1:414 E DRINKER ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-2469
Mailing Address - Country:US
Mailing Address - Phone:570-207-7846
Mailing Address - Fax:570-207-2788
Practice Address - Street 1:414 E DRINKER ST
Practice Address - Street 2:SUITE 102
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-2469
Practice Address - Country:US
Practice Address - Phone:570-207-7846
Practice Address - Fax:570-207-2788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004885133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty