Provider Demographics
NPI:1083227656
Name:ADVANCED NUTRITION SERVICES, LLC
Entity type:Organization
Organization Name:ADVANCED NUTRITION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTRUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD
Authorized Official - Phone:505-459-5143
Mailing Address - Street 1:916 FAYE PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-5510
Mailing Address - Country:US
Mailing Address - Phone:505-459-5143
Mailing Address - Fax:
Practice Address - Street 1:2920 CARLISLE BLVD NE, STE A1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2867
Practice Address - Country:US
Practice Address - Phone:505-308-4797
Practice Address - Fax:855-951-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty