Provider Demographics
NPI:1124881545
Name:EARTHSOUL NUTRITION THERAPY PLLC
Entity type:Organization
Organization Name:EARTHSOUL NUTRITION THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIERROS
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:603-545-1553
Mailing Address - Street 1:15 BRAMHALL ST APT 4
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3122
Mailing Address - Country:US
Mailing Address - Phone:603-793-3221
Mailing Address - Fax:
Practice Address - Street 1:15 BRAMHALL ST APT 4
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3122
Practice Address - Country:US
Practice Address - Phone:603-793-3221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-31
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty