Provider Demographics
NPI:1033972005
Name:BAREFOOT NURSE NUTRITIONIST, LLC
Entity Type:Organization
Organization Name:BAREFOOT NURSE NUTRITIONIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DYCUS
Authorized Official - Suffix:
Authorized Official - Credentials:LDN
Authorized Official - Phone:815-451-9367
Mailing Address - Street 1:4119 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-7501
Mailing Address - Country:US
Mailing Address - Phone:815-451-9367
Mailing Address - Fax:
Practice Address - Street 1:4119 DEAN ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-7501
Practice Address - Country:US
Practice Address - Phone:815-451-9367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty