Organization
EXCELLIS NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STACIE VANESSA ELLIS PHD, RDN, LD (OWNER AND REGISTERED DIETITIAN)
(469) 708-6940
Entity
Organization
Contact information
Practice address
475 E FM 1382 UNIT 2572, CEDAR HILL, TX 75106-5118
(469) 708-6940
Mailing address
PO BOX 2572, CEDAR HILL, TX 75106-2572
(469) 708-6940
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
01/16/2024
Last updated
01/16/2024
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