Provider Demographics
NPI:1003227570
Name:RESTORATIVE NUTRITION, LLC
Entity Type:Organization
Organization Name:RESTORATIVE NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:OUHRABKA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN
Authorized Official - Phone:401-529-7925
Mailing Address - Street 1:14 THURSTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-1760
Mailing Address - Country:US
Mailing Address - Phone:401-529-7925
Mailing Address - Fax:
Practice Address - Street 1:14 THURSTON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-1760
Practice Address - Country:US
Practice Address - Phone:401-529-7925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-18
Last Update Date:2014-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty