Provider Demographics
NPI:1033469283
Name:NUTRITION CONNECTION, LLC
Entity Type:Organization
Organization Name:NUTRITION CONNECTION, LLC
Other - Org Name:JENNIFER PAPASTEPHANOU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:PAPASTEPHANOU
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN, CDE
Authorized Official - Phone:410-321-5050
Mailing Address - Street 1:203 PURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5252
Mailing Address - Country:US
Mailing Address - Phone:410-321-5050
Mailing Address - Fax:410-321-5050
Practice Address - Street 1:1734 YORK RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-5606
Practice Address - Country:US
Practice Address - Phone:410-252-2273
Practice Address - Fax:410-321-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDN00262133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1467414318Medicare UPIN
MD974RMedicare PIN