Provider Demographics
NPI:1154038594
Name:KLL NUTRITION, LLC
Entity type:Organization
Organization Name:KLL NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LORENZ
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:616-443-7775
Mailing Address - Street 1:2727 REEDS LAKE BLVD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2053
Mailing Address - Country:US
Mailing Address - Phone:616-443-7775
Mailing Address - Fax:
Practice Address - Street 1:2727 REEDS LAKE BLVD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2053
Practice Address - Country:US
Practice Address - Phone:616-443-7775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty