Provider Demographics
NPI:1346434305
Name:NUTRITION COACHING, LLC
Entity Type:Organization
Organization Name:NUTRITION COACHING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GLOEDE
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDE
Authorized Official - Phone:703-516-4973
Mailing Address - Street 1:5275 LEE HWY
Mailing Address - Street 2:SUITE #101
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-1619
Mailing Address - Country:US
Mailing Address - Phone:703-516-4973
Mailing Address - Fax:703-358-8703
Practice Address - Street 1:5275 LEE HWY
Practice Address - Street 2:SUITE #101
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-1619
Practice Address - Country:US
Practice Address - Phone:703-516-4973
Practice Address - Fax:703-358-8703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA491536Medicare PIN