Provider Demographics
NPI:1225639115
Name:CORE NUTRITION LLC
Entity Type:Organization
Organization Name:CORE NUTRITION LLC
Other - Org Name:CORE WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:N
Authorized Official - Last Name:CARSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:RD LD
Authorized Official - Phone:240-274-2048
Mailing Address - Street 1:10201 WINCOPIN CIR APT 701
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3461
Mailing Address - Country:US
Mailing Address - Phone:240-274-2048
Mailing Address - Fax:
Practice Address - Street 1:10201 WINCOPIN CIR # 701
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3461
Practice Address - Country:US
Practice Address - Phone:240-274-2048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty