Provider Demographics
NPI:1962822056
Name:SUPPLEMENT YOU INC.
Entity Type:Organization
Organization Name:SUPPLEMENT YOU INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRISTA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:610-451-1787
Mailing Address - Street 1:844 CANAL RD
Mailing Address - Street 2:
Mailing Address - City:WOMELSDORF
Mailing Address - State:PA
Mailing Address - Zip Code:19567-9124
Mailing Address - Country:US
Mailing Address - Phone:610-451-1787
Mailing Address - Fax:610-589-4619
Practice Address - Street 1:844 CANAL RD
Practice Address - Street 2:
Practice Address - City:WOMELSDORF
Practice Address - State:PA
Practice Address - Zip Code:19567-9124
Practice Address - Country:US
Practice Address - Phone:610-451-1787
Practice Address - Fax:610-589-4619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN601310174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty