Individual
MARY PHELPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CNS
Contact information
Practice address
1236 PENNSYLVANIA AVE SE, WASHINGTON, DC 20003-2226
(609) 477-3050
Mailing address
2909 N ST SE, WASHINGTON, DC 20019-2139
(609) 477-3050
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
NU10000021
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17448
CERTIFIED NUTRITION SPECIALIST
—
01
—
NU10000021
LICENSE NUMBER
DC
Enumeration date
07/22/2019
Last updated
07/22/2019
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