Provider Demographics
NPI:1548000748
Name:REFORMED NUTRITION, LLC
Entity type:Organization
Organization Name:REFORMED NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & CLINICAL DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:BULLOCK
Authorized Official - Last Name:WHEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:864-907-3636
Mailing Address - Street 1:30 W AVONDALE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-4751
Mailing Address - Country:US
Mailing Address - Phone:864-907-3636
Mailing Address - Fax:864-642-6949
Practice Address - Street 1:30 W AVONDALE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-4751
Practice Address - Country:US
Practice Address - Phone:864-907-3636
Practice Address - Fax:864-642-6949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty