Provider Demographics
NPI:1073725750
Name:NUTRITION MATTERS
Entity Type:Organization
Organization Name:NUTRITION MATTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:410-476-9776
Mailing Address - Street 1:PO BOX 630
Mailing Address - Street 2:4014 MAIN STREET
Mailing Address - City:TRAPPE
Mailing Address - State:MD
Mailing Address - Zip Code:21673-0630
Mailing Address - Country:US
Mailing Address - Phone:410-476-9776
Mailing Address - Fax:410-476-3141
Practice Address - Street 1:4014 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TRAPPE
Practice Address - State:MD
Practice Address - Zip Code:21673-0630
Practice Address - Country:US
Practice Address - Phone:410-476-9776
Practice Address - Fax:410-476-3141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD01059133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD840M534FMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE
MD840MMedicare ID - Type UnspecifiedGROUP NUMBER