Provider Demographics
NPI:1033861281
Name:NUTRITION WITH BARISSA LLC
Entity Type:Organization
Organization Name:NUTRITION WITH BARISSA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-378-6537
Mailing Address - Street 1:PO BOX 4041
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46082-4041
Mailing Address - Country:US
Mailing Address - Phone:317-378-6537
Mailing Address - Fax:
Practice Address - Street 1:13295 ILLINOIS ST STE 130
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3026
Practice Address - Country:US
Practice Address - Phone:317-755-4234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty