Provider Demographics
NPI:1548221682
Name:LIVE NUTRITION INC
Entity Type:Organization
Organization Name:LIVE NUTRITION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITIONISST OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RD,LDN,FADA,CDE
Authorized Official - Phone:508-896-9080
Mailing Address - Street 1:26 WAMPUM DR
Mailing Address - Street 2:PO BOX 1709
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-1956
Mailing Address - Country:US
Mailing Address - Phone:508-896-9080
Mailing Address - Fax:508-896-3399
Practice Address - Street 1:26 WAMPUM DR
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-1956
Practice Address - Country:US
Practice Address - Phone:508-896-9080
Practice Address - Fax:508-896-3399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANU445133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANU445OtherMASSACHUSETTS LICENSE
MAMT0023Medicare ID - Type UnspecifiedNUTRITIONIST