Provider Demographics
NPI:1508573767
Name:NOURISH THE LOVE
Entity Type:Organization
Organization Name:NOURISH THE LOVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIELY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-360-5338
Mailing Address - Street 1:6180 N CAMINO PADRE ISIDORO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-4023
Mailing Address - Country:US
Mailing Address - Phone:520-360-5338
Mailing Address - Fax:520-300-7033
Practice Address - Street 1:6180 N CAMINO PADRE ISIDORO
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-4023
Practice Address - Country:US
Practice Address - Phone:520-360-5338
Practice Address - Fax:520-300-7033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty