Provider Demographics
NPI:1154979250
Name:PRIMARY NUTRITION CONSULTING LLC
Entity type:Organization
Organization Name:PRIMARY NUTRITION CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:AMELIA
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:985-705-6738
Mailing Address - Street 1:73043 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-5917
Mailing Address - Country:US
Mailing Address - Phone:985-705-6738
Mailing Address - Fax:
Practice Address - Street 1:71667 LEVESON ST
Practice Address - Street 2:
Practice Address - City:ABITA SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70420-3635
Practice Address - Country:US
Practice Address - Phone:985-705-6738
Practice Address - Fax:985-327-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-31
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty