Provider Demographics
NPI:1558730960
Name:NUTRITIONAL HEALING LLC
Entity Type:Organization
Organization Name:NUTRITIONAL HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NUTRITIONIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:920-358-5764
Mailing Address - Street 1:400 N RICHMOND ST STE F
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-4602
Mailing Address - Country:US
Mailing Address - Phone:920-358-5764
Mailing Address - Fax:
Practice Address - Street 1:400 N RICHMOND ST STE F
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-4602
Practice Address - Country:US
Practice Address - Phone:920-358-5764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty