Provider Demographics
NPI:1790107951
Name:TELENUTRITION THERAPY
Entity Type:Organization
Organization Name:TELENUTRITION THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:706-951-8118
Mailing Address - Street 1:1880 AUBURN LN
Mailing Address - Street 2:SUITE 24H
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-5196
Mailing Address - Country:US
Mailing Address - Phone:706-951-8118
Mailing Address - Fax:
Practice Address - Street 1:1880 AUBURN LN
Practice Address - Street 2:SUITE 24H
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-5196
Practice Address - Country:US
Practice Address - Phone:706-951-8118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty