Provider Demographics
NPI:1366769028
Name:THE NUTRITION FAIRY LLC
Entity type:Organization
Organization Name:THE NUTRITION FAIRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RAELEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS LDN
Authorized Official - Phone:302-252-7688
Mailing Address - Street 1:1813 ARLENE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-4001
Mailing Address - Country:US
Mailing Address - Phone:302-999-0814
Mailing Address - Fax:302-999-0692
Practice Address - Street 1:1813 ARLENE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-4001
Practice Address - Country:US
Practice Address - Phone:302-999-0814
Practice Address - Fax:302-999-0692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDE0000409133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty