Provider Demographics
NPI:1053865071
Name:BALANCED NUTRITION FOR LIFE
Entity Type:Organization
Organization Name:BALANCED NUTRITION FOR LIFE
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LIMPERT
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:704-449-4293
Mailing Address - Street 1:6047 TYVOLA GLEN CIR STE 214
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-6438
Mailing Address - Country:US
Mailing Address - Phone:704-449-4293
Mailing Address - Fax:704-496-2233
Practice Address - Street 1:6047 TYVOLA GLEN CIR STE 214
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-6438
Practice Address - Country:US
Practice Address - Phone:704-449-4293
Practice Address - Fax:704-496-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004308133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty