Provider Demographics
NPI:1063119303
Name:LAUREN LEEDY NUTRITION LLC
Entity type:Organization
Organization Name:LAUREN LEEDY NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LEEDY
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:509-318-4471
Mailing Address - Street 1:10530 ASHWORTH AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8938
Mailing Address - Country:US
Mailing Address - Phone:509-318-4471
Mailing Address - Fax:206-829-6599
Practice Address - Street 1:10530 ASHWORTH AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8938
Practice Address - Country:US
Practice Address - Phone:509-318-4471
Practice Address - Fax:206-829-6599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1962067199OtherPROVIDER NPI