Provider Demographics
NPI:1194436915
Name:MINDFULL NEWTRITION LLC
Entity type:Organization
Organization Name:MINDFULL NEWTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONET
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:CFNC
Authorized Official - Phone:800-671-8193
Mailing Address - Street 1:82 EWING DR
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-3639
Mailing Address - Country:US
Mailing Address - Phone:800-671-8193
Mailing Address - Fax:
Practice Address - Street 1:82 EWING DR
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-3639
Practice Address - Country:US
Practice Address - Phone:800-671-8193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals