| Boundless Nutrition Llc | |
|
13112 Moss Ranch Ln Fairfax VA 22033-3524 | |
| (703) 705-2720 | |
| Not Available |
| Full Name | Boundless Nutrition Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 13112 Moss Ranch Ln, Fairfax, Virginia |
| Authorized Official Name and Position | Miriam Eackloff (OWNER) |
| Authorized Official Contact | 7037052720 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Boundless Nutrition Llc 13112 Moss Ranch Ln Fairfax VA 22033-3524 Ph: (703) 705-2720 | Boundless Nutrition Llc 13112 Moss Ranch Ln Fairfax VA 22033-3524 Ph: (703) 705-2720 |
| NPI Number | 1033828694 |
|---|---|
| Provider Enumeration Date | 11/22/2022 |
| Last Update Date | 11/22/2022 |
| Medicare PECOS PAC ID | 6103295548 |
|---|---|
| Medicare Enrollment ID | O20221229000456 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033828694 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Miriam Sara Eackloff |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1427608165 PECOS PAC ID: 6901239136 Enrollment ID: I20191202002615 |
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