Provider Demographics
NPI:1427880665
Name:MIEUX NUTRITION AND WELLBEING LLC
Entity type:Organization
Organization Name:MIEUX NUTRITION AND WELLBEING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:BERTHOUMIEUX
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:646-465-0475
Mailing Address - Street 1:2093 PHILADELPHIA PIKE # 9455
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-2424
Mailing Address - Country:US
Mailing Address - Phone:646-465-0475
Mailing Address - Fax:
Practice Address - Street 1:941 N LEITHGOW ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1430
Practice Address - Country:US
Practice Address - Phone:646-465-0475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty