Provider Demographics
NPI:1881341261
Name:QUEEN OF HEARTS NUTRITION LLC
Entity type:Organization
Organization Name:QUEEN OF HEARTS NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:K
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LDN, MS
Authorized Official - Phone:540-750-1879
Mailing Address - Street 1:1115 PARK ROW SOUTH SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-3883
Mailing Address - Country:US
Mailing Address - Phone:540-750-1879
Mailing Address - Fax:
Practice Address - Street 1:1115 PARK ROW SOUTH SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-3883
Practice Address - Country:US
Practice Address - Phone:540-750-1879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty