Provider Demographics
NPI:1518540483
Name:NOURISHING EXPERT LLC
Entity Type:Organization
Organization Name:NOURISHING EXPERT LLC
Other - Org Name:NOURISHING EXPERT LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAVANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KETHAMUKKALA
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LDN
Authorized Official - Phone:919-342-6179
Mailing Address - Street 1:3508 LILY ORCHARD WAY
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-9601
Mailing Address - Country:US
Mailing Address - Phone:919-342-6179
Mailing Address - Fax:919-342-5871
Practice Address - Street 1:3508 LILY ORCHARD WAY
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27539-9601
Practice Address - Country:US
Practice Address - Phone:919-342-6179
Practice Address - Fax:919-342-5871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty