| NPI | 1417718602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACIE VANESSA ELLIS Owner And Registered Dietitian 469-708-6940 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Enumeration Date | 2024-01-16 |
| Last Update Date | 2024-01-16 |