Advantage Nutrition & Wellness, LLC
Organization Active NPI Registered Dietitian · Allentown, PA
NPI 1710168638 · NPPES record last updated May 13, 2019
Key facts
- NPI
- 1710168638
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- DN001283 (PA)
- Legal business name
- ADVANTAGE NUTRITION & WELLNESS, LLC
- Practice address
- 961 Marcon Blvd Ste 115
Allentown, PA 18109-9371 - Phone
- (610) 443-1885
- Fax
- (610) 443-1685
- NPI assigned
- Nov 20, 2007
- Organization subpart
- No
Authorized official
- Name
- Mrs. Jennifer Marie Doane, RD, LDN, ATC
- Title
- President
- Phone
- (610) 443-1885
Practitioners 3
-
Jacqueline Jarrett, RD, LDN, CDE
-
Michele A Waide, RDN, LDN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091027000009 | PA | Part B Supplier - Clinic/Group Practice | 2961549860 |
Receives reassigned benefits from 2 practitioners Practice locations: Allentown, PA |
National Provider Directory
Locations
961 Marcon Blvd
Ste 115
Allentown, PA 18109
Phone (610) 443-1885
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian |
133V00000X | DN001283 | PA | Yes |
| Registered Dietitian |
133V00000X | DN003573 | PA |
Addresses
Primary practice location
961 Marcon Blvd Ste 115
Allentown, PA 18109-9371
Mailing address
961 Marcon Blvd Ste 115
Allentown, PA 18109-9371
Phone (610) 443-1885
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102392708 | Medicaid | PA |
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.