Provider Demographics
NPI:1063235539
Name:LIFE WITH SUBSTANCE
Entity type:Organization
Organization Name:LIFE WITH SUBSTANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NANKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-341-7787
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:PEOSTA
Mailing Address - State:IA
Mailing Address - Zip Code:52068-0086
Mailing Address - Country:US
Mailing Address - Phone:563-341-7787
Mailing Address - Fax:
Practice Address - Street 1:13318 W CLAY DR
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-9665
Practice Address - Country:US
Practice Address - Phone:563-341-7787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty