Provider Demographics
NPI:1962806414
Name:FUEL. NUTRITION CONULTING
Entity type:Organization
Organization Name:FUEL. NUTRITION CONULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LORI
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:850-694-3322
Mailing Address - Street 1:1114 THOMASVILLE RD STE G
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-6273
Mailing Address - Country:US
Mailing Address - Phone:850-694-3322
Mailing Address - Fax:850-298-1131
Practice Address - Street 1:1114 THOMASVILLE RD STE G
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6273
Practice Address - Country:US
Practice Address - Phone:850-694-3322
Practice Address - Fax:850-298-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4473174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty