Organization
REAL LIFE NUTRITION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHERINE M SHAW R.D., C.D.E (OWNER)
(540) 797-0593
Entity
Organization
Contact information
Practice address
5375 FALLOWATER LN, ROANOKE, VA 24018-2401
(540) 797-0593
Mailing address
1802 ARLINGTON RD SW, ROANOKE, VA 24015-2808
(540) 797-0593
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
846139
VA
Other
Enumeration date
07/03/2006
Last updated
03/22/2022
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