Provider Demographics
NPI:1659132629
Name:EDDE NUTRITION
Entity type:Organization
Organization Name:EDDE NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIE
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:STAMBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:717-779-7498
Mailing Address - Street 1:1531 WINSFORD LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-9080
Mailing Address - Country:US
Mailing Address - Phone:717-779-7498
Mailing Address - Fax:
Practice Address - Street 1:1531 WINSFORD LN
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-9080
Practice Address - Country:US
Practice Address - Phone:717-779-7498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service