Provider Demographics
NPI:1235832098
Name:INNATE LIVING INC
Entity Type:Organization
Organization Name:INNATE LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:715-218-1734
Mailing Address - Street 1:9950 SIBERIAN DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-5624
Mailing Address - Country:US
Mailing Address - Phone:715-218-1734
Mailing Address - Fax:808-320-1274
Practice Address - Street 1:9950 SIBERIAN DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-5624
Practice Address - Country:US
Practice Address - Phone:715-218-1734
Practice Address - Fax:808-320-1274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty