Provider Demographics
NPI:1013567031
Name:NOURISH BY GINA LLC
Entity Type:Organization
Organization Name:NOURISH BY GINA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBETTA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:203-206-3873
Mailing Address - Street 1:55 W DAYTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-5309
Mailing Address - Country:US
Mailing Address - Phone:203-206-3873
Mailing Address - Fax:
Practice Address - Street 1:352 MAIN ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:CT
Practice Address - Zip Code:06422-1645
Practice Address - Country:US
Practice Address - Phone:203-206-3873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty