Provider Demographics
NPI:1316807589
Name:GENTLY NOURISH NUTRITION THERAPY LLC
Entity type:Organization
Organization Name:GENTLY NOURISH NUTRITION THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN
Authorized Official - Phone:217-521-1712
Mailing Address - Street 1:1335 FINLEY CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT ZION
Mailing Address - State:IL
Mailing Address - Zip Code:62549-1020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1335 FINLEY CT
Practice Address - Street 2:
Practice Address - City:MOUNT ZION
Practice Address - State:IL
Practice Address - Zip Code:62549-1020
Practice Address - Country:US
Practice Address - Phone:217-521-1712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-12
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty