Provider Demographics
NPI:1548142458
Name:NUTRAMIRA LLC
Entity type:Organization
Organization Name:NUTRAMIRA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTTY
Authorized Official - Middle Name:LORIE
Authorized Official - Last Name:BONDURANT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LDN
Authorized Official - Phone:334-740-5861
Mailing Address - Street 1:540 DEVALL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-5986
Mailing Address - Country:US
Mailing Address - Phone:334-740-5861
Mailing Address - Fax:
Practice Address - Street 1:1158 ALAN AVE APT A
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-8310
Practice Address - Country:US
Practice Address - Phone:334-740-5861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-22
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty