Provider Demographics
NPI:1912482076
Name:LOVELIFE NUTRITION AND WELLNESS
Entity Type:Organization
Organization Name:LOVELIFE NUTRITION AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERSANI
Authorized Official - Suffix:
Authorized Official - Credentials:MPH,RDN,LDN
Authorized Official - Phone:267-939-4349
Mailing Address - Street 1:1712 TULIP ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-2427
Mailing Address - Country:US
Mailing Address - Phone:484-280-9239
Mailing Address - Fax:267-573-3071
Practice Address - Street 1:1712 TULIP ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-2427
Practice Address - Country:US
Practice Address - Phone:484-280-9239
Practice Address - Fax:267-573-3071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-25
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service