Provider Demographics
NPI:1528651064
Name:PURELY ROOTED NUTRITION AND WELLNESS
Entity type:Organization
Organization Name:PURELY ROOTED NUTRITION AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:GOWDY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CNS, LDN, CHHP
Authorized Official - Phone:814-777-8919
Mailing Address - Street 1:850 GALEN DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-1164
Mailing Address - Country:US
Mailing Address - Phone:814-777-8919
Mailing Address - Fax:
Practice Address - Street 1:850 GALEN DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-1164
Practice Address - Country:US
Practice Address - Phone:814-777-8919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty