Organization
GOSIMPLE NUTRITION LLC
Active
Other names
GoSimple Nutrition
Organization subpart
No
Provider details
NPI number
Authorized official
AMINTA BULLARD RD (OWNER)
(240) 241-0519
Entity
Organization
Contact information
Practice address
10111 MARTIN LUTHER KING JR HWY STE 118, BOWIE, MD 20720-4226
(240) 241-0519
Mailing address
11104 CEDAR LN, BELTSVILLE, MD 20705-2801
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DX4020
MD
Other
Enumeration date
11/19/2017
Last updated
11/19/2017
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