Provider Demographics
NPI:1407724404
Name:NOURISH WELL INTEGRATIVE NUTRITION, LLC
Entity type:Organization
Organization Name:NOURISH WELL INTEGRATIVE NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/ CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DOLAN, DCN, CNS, LDN
Authorized Official - Suffix:
Authorized Official - Credentials:DCN, CNS, LDN
Authorized Official - Phone:703-468-1241
Mailing Address - Street 1:481 CARLISLE DR # D1
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4882
Mailing Address - Country:US
Mailing Address - Phone:703-468-1241
Mailing Address - Fax:703-468-1241
Practice Address - Street 1:481 CARLISLE DR # D1
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4882
Practice Address - Country:US
Practice Address - Phone:703-468-1241
Practice Address - Fax:703-468-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-29
Last Update Date:2025-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty