Provider Demographics
NPI:1083826317
Name:CONTEMPORARY NUTRITION INC
Entity Type:Organization
Organization Name:CONTEMPORARY NUTRITION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:RD LDN
Authorized Official - Phone:252-648-8777
Mailing Address - Street 1:147 NC HIGHWAY 24 STE 101
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-8982
Mailing Address - Country:US
Mailing Address - Phone:252-648-8777
Mailing Address - Fax:252-648-8087
Practice Address - Street 1:147 NC HIGHWAY 24 STE 101
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-8982
Practice Address - Country:US
Practice Address - Phone:252-648-8777
Practice Address - Fax:522-648-8087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC910311133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1477XOtherBLUE CROSS BLUE SHIELD