Provider Demographics
NPI:1336641299
Name:LYTLE, MILLENNIA RUTH (ND, CNS)
Entity Type:Individual
Prefix:DR
First Name:MILLENNIA
Middle Name:RUTH
Last Name:LYTLE
Suffix:
Gender:F
Credentials:ND, CNS
Other - Prefix:
Other - First Name:MILLIE
Other - Middle Name:
Other - Last Name:LYTLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:135 CLARKSON AVE
Mailing Address - Street 2:F8
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226
Mailing Address - Country:US
Mailing Address - Phone:844-441-9661
Mailing Address - Fax:888-255-5088
Practice Address - Street 1:135 CLARKSON AVE
Practice Address - Street 2:F8
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226
Practice Address - Country:US
Practice Address - Phone:844-441-9661
Practice Address - Fax:888-255-5088
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CNS16383133N00000X
DC0057175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133N00000XDietary & Nutritional Service ProvidersNutritionist