Provider Demographics
NPI:1467910638
Name:NUTRIBRIDGE LLC
Entity Type:Organization
Organization Name:NUTRIBRIDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:860-716-0358
Mailing Address - Street 1:158 BLUE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-5835
Mailing Address - Country:US
Mailing Address - Phone:860-716-0358
Mailing Address - Fax:
Practice Address - Street 1:645 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2907
Practice Address - Country:US
Practice Address - Phone:860-716-0358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty