Provider Demographics
NPI:1780291724
Name:NOURISH WELL LLC
Entity type:Organization
Organization Name:NOURISH WELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:MASELLI
Authorized Official - Last Name:WIND
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LD
Authorized Official - Phone:816-204-0651
Mailing Address - Street 1:5900 BALCONES DR STE 4201
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4257
Mailing Address - Country:US
Mailing Address - Phone:816-204-0651
Mailing Address - Fax:
Practice Address - Street 1:5900 BALCONES DR STE 4201
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4257
Practice Address - Country:US
Practice Address - Phone:816-204-0651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty