Provider Demographics
NPI:1396406393
Name:CULTIVATE NUTRITION CONSULTING
Entity Type:Organization
Organization Name:CULTIVATE NUTRITION CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIANNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN
Authorized Official - Phone:508-561-5920
Mailing Address - Street 1:185 COMMONWEALTH RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-5055
Mailing Address - Country:US
Mailing Address - Phone:508-561-5920
Mailing Address - Fax:
Practice Address - Street 1:185 COMMONWEALTH RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-5055
Practice Address - Country:US
Practice Address - Phone:508-561-5920
Practice Address - Fax:617-614-9037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-03
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty