Provider Demographics
NPI:1043066541
Name:SIMPLY NOURISH, LLC
Entity type:Organization
Organization Name:SIMPLY NOURISH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LDN
Authorized Official - Phone:985-969-2045
Mailing Address - Street 1:1905 W THOMAS ST
Mailing Address - Street 2:SUITE D-196
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401
Mailing Address - Country:US
Mailing Address - Phone:985-969-2045
Mailing Address - Fax:
Practice Address - Street 1:42544 FOREST LN
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403
Practice Address - Country:US
Practice Address - Phone:985-969-2045
Practice Address - Fax:985-221-8771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1083967731OtherLORI BROWN