| NPI | 1942787122 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE INGENITO Credentialing Specialists 570-352-3063 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2018-07-20 |
| Last Update Date | 2022-04-05 |