Provider Demographics
NPI:1932886629
Name:RENEW NUTRITION LLC
Entity type:Organization
Organization Name:RENEW NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:910-227-9662
Mailing Address - Street 1:1102 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2517
Mailing Address - Country:US
Mailing Address - Phone:919-738-7520
Mailing Address - Fax:910-795-0689
Practice Address - Street 1:1102 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2517
Practice Address - Country:US
Practice Address - Phone:919-738-7520
Practice Address - Fax:910-795-0689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty