Provider Demographics
NPI:1205103017
Name:WHOLE HEALTH NUTRITION, PLLC
Entity type:Organization
Organization Name:WHOLE HEALTH NUTRITION, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:802-999-9207
Mailing Address - Street 1:302 MOUNTAIN VIEW DR.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446
Mailing Address - Country:US
Mailing Address - Phone:802-999-9207
Mailing Address - Fax:802-488-5704
Practice Address - Street 1:302 MOUNTAIN VIEW DR.
Practice Address - Street 2:SUITE 101
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446
Practice Address - Country:US
Practice Address - Phone:802-999-9207
Practice Address - Fax:802-488-5704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0740061847133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty