Provider Demographics
NPI:1154683142
Name:NUTRITION YOUR WAY LLC
Entity type:Organization
Organization Name:NUTRITION YOUR WAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:401-783-8057
Mailing Address - Street 1:110 WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-2827
Mailing Address - Country:US
Mailing Address - Phone:401-783-8057
Mailing Address - Fax:
Practice Address - Street 1:110 WOODBINE RD
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-2827
Practice Address - Country:US
Practice Address - Phone:401-783-8057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00697133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty