Basic Information
| Provider Information | |||||||||
| NPI: | 1699289132 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | URENU LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2412 WINCHESTER BLVD | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3213487368 | ||||||||
| FaxNumber: | 8889741047 | ||||||||
| Practice Location | |||||||||
| Address1: | 2412 WINCHESTER BLVD | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347433627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3213487368 | ||||||||
| FaxNumber: | 8889741047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2017 | ||||||||
| LastUpdateDate: | 11/20/2017 | ||||||||
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| AuthorizedOfficialLastName: | HENRY | ||||||||
| AuthorizedOfficialFirstName: | KALEENA | ||||||||
| AuthorizedOfficialMiddleName: | FRANCOIS | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 4073948077 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133NN1002X | N | 193200000X MULTI-SPECIALTY GROUP | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | 174400000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 174H00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Health Educator |
No ID Information.