Provider Demographics
NPI:1801529615
Name:SIMONE THERESE NUTRITION
Entity type:Organization
Organization Name:SIMONE THERESE NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RD
Authorized Official - Prefix:
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:828-553-6832
Mailing Address - Street 1:64 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3429
Mailing Address - Country:US
Mailing Address - Phone:828-553-6832
Mailing Address - Fax:
Practice Address - Street 1:61 LLANFAIR RD UNIT A1
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-3314
Practice Address - Country:US
Practice Address - Phone:828-553-6832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty