Provider Demographics
NPI:1245592047
Name:JUST NUTRITIOUS
Entity type:Organization
Organization Name:JUST NUTRITIOUS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONOVER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:757-655-5483
Mailing Address - Street 1:2012 CASTLEREA CT
Mailing Address - Street 2:APT 203
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-3163
Mailing Address - Country:US
Mailing Address - Phone:757-655-5483
Mailing Address - Fax:
Practice Address - Street 1:2012 CASTLEREA CT
Practice Address - Street 2:APT 203
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-3163
Practice Address - Country:US
Practice Address - Phone:757-655-5483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY963115133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty