Provider Demographics
NPI:1467985614
Name:INNERWORLD NUTRITION LLC
Entity Type:Organization
Organization Name:INNERWORLD NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, CDN, LDN
Authorized Official - Phone:860-652-5719
Mailing Address - Street 1:11 HIGH ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-2125
Mailing Address - Country:US
Mailing Address - Phone:860-652-5719
Mailing Address - Fax:
Practice Address - Street 1:11 HIGH ST
Practice Address - Street 2:SUITE 111
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-2125
Practice Address - Country:US
Practice Address - Phone:860-652-5719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000781133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty