Provider Demographics
NPI:1033849799
Name:FUNCTION WELL NUTRITION
Entity Type:Organization
Organization Name:FUNCTION WELL NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:RANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:617-206-3751
Mailing Address - Street 1:PO BOX 854
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-0854
Mailing Address - Country:US
Mailing Address - Phone:617-206-3751
Mailing Address - Fax:
Practice Address - Street 1:29 CHESTNUT ST UNIT A
Practice Address - Street 2:
Practice Address - City:FOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:02035-1497
Practice Address - Country:US
Practice Address - Phone:617-206-3751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty