Provider Demographics
NPI:1972993582
Name:ENCOMPASS NUTRITION
Entity type:Organization
Organization Name:ENCOMPASS NUTRITION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LUDWIG
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:651-207-7197
Mailing Address - Street 1:2209 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4345
Mailing Address - Country:US
Mailing Address - Phone:651-207-7197
Mailing Address - Fax:877-992-0282
Practice Address - Street 1:8519 EAGLE POINT BLVD # 150
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-8629
Practice Address - Country:US
Practice Address - Phone:651-207-7197
Practice Address - Fax:877-992-0282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1648133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty