Provider Demographics
NPI:1932735917
Name:FUELED & WELL NUTRITION LLC
Entity Type:Organization
Organization Name:FUELED & WELL NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEHRLE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:203-909-0053
Mailing Address - Street 1:2100 HERITAGE AVE APT 4301
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-5529
Mailing Address - Country:US
Mailing Address - Phone:203-909-0053
Mailing Address - Fax:
Practice Address - Street 1:2100 HERITAGE AVE APT 4301
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-5529
Practice Address - Country:US
Practice Address - Phone:203-909-0053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-21
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty