Provider Demographics
NPI:1750787610
Name:YOUR WELLNESS CONSULTANTS
Entity type:Organization
Organization Name:YOUR WELLNESS CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN, CPT
Authorized Official - Phone:610-331-5439
Mailing Address - Street 1:1 PRESIDENTIAL BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1007
Mailing Address - Country:US
Mailing Address - Phone:610-331-5439
Mailing Address - Fax:
Practice Address - Street 1:2835 TYSON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1415
Practice Address - Country:US
Practice Address - Phone:610-331-5439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004701133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1508142696OtherNPI
PA1609167543OtherNPI