Provider Demographics
NPI:1376977751
Name:APPLIED NUTRITION CENTER,LLC
Entity Type:Organization
Organization Name:APPLIED NUTRITION CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RD, OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ASWAD
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:401-245-2742
Mailing Address - Street 1:2 RICHMOND SQUARE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906
Mailing Address - Country:US
Mailing Address - Phone:401-245-2742
Mailing Address - Fax:401-865-6038
Practice Address - Street 1:2 RICHMOND SQ
Practice Address - Street 2:SUITE 105
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5100
Practice Address - Country:US
Practice Address - Phone:401-245-2742
Practice Address - Fax:401-865-6038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00470133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI719003491Medicare PIN