Provider Demographics
NPI:1568109056
Name:MARSTALL NUTRITIONAL CONSULTING LLC
Entity Type:Organization
Organization Name:MARSTALL NUTRITIONAL CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:RD LD
Authorized Official - Phone:316-630-8243
Mailing Address - Street 1:8100 E 22ND STREET N
Mailing Address - Street 2:BUILDING 1500 SUITE D
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226
Mailing Address - Country:US
Mailing Address - Phone:316-630-8243
Mailing Address - Fax:
Practice Address - Street 1:8100 E 22ND STREET N
Practice Address - Street 2:BUILDING 1500 SUITE D
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226
Practice Address - Country:US
Practice Address - Phone:316-630-8243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARSTALL NUTRITIONAL CONSULTING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty