Provider Demographics
NPI:1780071738
Name:PARTNERING4WELLNESS
Entity type:Organization
Organization Name:PARTNERING4WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED LICENSED NUTRITIONIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHON
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CNS, LDN
Authorized Official - Phone:301-466-6493
Mailing Address - Street 1:9603 GREYFIELD CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3180
Mailing Address - Country:US
Mailing Address - Phone:301-925-4209
Mailing Address - Fax:
Practice Address - Street 1:9603 GREYFIELD CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-3180
Practice Address - Country:US
Practice Address - Phone:301-925-4209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3766133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty