Provider Demographics
NPI:1720671787
Name:FABULOUS HEALING NUTRITION & WELLNESS LLC
Entity type:Organization
Organization Name:FABULOUS HEALING NUTRITION & WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:LIAT
Authorized Official - Middle Name:
Authorized Official - Last Name:NADLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CNS, LD
Authorized Official - Phone:503-773-9170
Mailing Address - Street 1:11285 NW 317TH PL
Mailing Address - Street 2:
Mailing Address - City:NORTH PLAINS
Mailing Address - State:OR
Mailing Address - Zip Code:97133-6219
Mailing Address - Country:US
Mailing Address - Phone:503-773-9170
Mailing Address - Fax:954-908-6525
Practice Address - Street 1:11285 NW 317TH PL
Practice Address - Street 2:
Practice Address - City:NORTH PLAINS
Practice Address - State:OR
Practice Address - Zip Code:97133-6219
Practice Address - Country:US
Practice Address - Phone:503-899-8204
Practice Address - Fax:954-908-6525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty