Provider Demographics
NPI:1841623097
Name:CIRCLE OF LIFE NUTRITION LLC
Entity type:Organization
Organization Name:CIRCLE OF LIFE NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:336-420-9567
Mailing Address - Street 1:1410 STONECROFT CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6095
Mailing Address - Country:US
Mailing Address - Phone:336-420-9567
Mailing Address - Fax:
Practice Address - Street 1:1410 STONECROFT CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6095
Practice Address - Country:US
Practice Address - Phone:336-420-9567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002793133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty