Provider Demographics
NPI:1609105089
Name:NUTRITION SOLUTIONS FOR LIFE LLC
Entity type:Organization
Organization Name:NUTRITION SOLUTIONS FOR LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:DOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:860-930-3672
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06022-0206
Mailing Address - Country:US
Mailing Address - Phone:860-930-3672
Mailing Address - Fax:
Practice Address - Street 1:109 TORRINGTON AVE
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06019-3326
Practice Address - Country:US
Practice Address - Phone:860-930-3672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00196133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty