Provider Demographics
NPI:1659083806
Name:BLUEPRINT NUTRITION AND FITNESS LLC
Entity Type:Organization
Organization Name:BLUEPRINT NUTRITION AND FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARRIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARABLE
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LDN
Authorized Official - Phone:704-999-5035
Mailing Address - Street 1:1528 DUCKWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-4315
Mailing Address - Country:US
Mailing Address - Phone:704-999-5035
Mailing Address - Fax:
Practice Address - Street 1:1528 DUCKWORTH AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-4315
Practice Address - Country:US
Practice Address - Phone:704-999-5035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-20
Last Update Date:2023-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty