Provider Demographics
NPI:1881462224
Name:NUTRIENT DENSE NUTRITION LLC
Entity type:Organization
Organization Name:NUTRIENT DENSE NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALE
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:225-828-8393
Mailing Address - Street 1:4036 S 183RD LN
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-7817
Mailing Address - Country:US
Mailing Address - Phone:225-828-8393
Mailing Address - Fax:
Practice Address - Street 1:4036 S 183RD LN
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-7817
Practice Address - Country:US
Practice Address - Phone:225-828-8393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty