Provider Demographics
NPI:1487310850
Name:LAINEY YOUNKIN NUTRITION
Entity type:Organization
Organization Name:LAINEY YOUNKIN NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAINEY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN
Authorized Official - Phone:636-346-7867
Mailing Address - Street 1:29 PERCIVAL ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-1725
Mailing Address - Country:US
Mailing Address - Phone:636-346-7867
Mailing Address - Fax:
Practice Address - Street 1:867 BOYLSTON STREET
Practice Address - Street 2:5TH FLOOR #1022
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2774
Practice Address - Country:US
Practice Address - Phone:636-346-7867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Single Specialty