Provider Demographics
NPI:1912726548
Name:KINSHIP NUTRITION LLC
Entity type:Organization
Organization Name:KINSHIP NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GUADAN FOGALL
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, MS
Authorized Official - Phone:206-650-6305
Mailing Address - Street 1:3717 BEACH DR SW APT 303
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3055
Mailing Address - Country:US
Mailing Address - Phone:206-650-6305
Mailing Address - Fax:
Practice Address - Street 1:3717 BEACH DR SW APT 303
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3055
Practice Address - Country:US
Practice Address - Phone:206-650-6305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center