Provider Demographics
NPI:1578136032
Name:COMBINED NUTRITION SOLUTIONS LLC
Entity Type:Organization
Organization Name:COMBINED NUTRITION SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RDN, LDN
Authorized Official - Phone:919-951-4345
Mailing Address - Street 1:78 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-3461
Mailing Address - Country:US
Mailing Address - Phone:919-951-4345
Mailing Address - Fax:
Practice Address - Street 1:6817 SOUTHPOINT PKWY STE 1203
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6296
Practice Address - Country:US
Practice Address - Phone:919-951-4345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8KLR2OtherBCBS FB ID#