Provider Demographics
NPI:1598180606
Name:VITAL NUTRITION, LLC
Entity Type:Organization
Organization Name:VITAL NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUECH
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:919-886-4140
Mailing Address - Street 1:2728 ARMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-9440
Mailing Address - Country:US
Mailing Address - Phone:919-886-4140
Mailing Address - Fax:919-526-7440
Practice Address - Street 1:711 IREDELL ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4862
Practice Address - Country:US
Practice Address - Phone:919-886-4140
Practice Address - Fax:919-526-7440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC989672133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1518118025Medicare PIN
NC1518118025Medicare UPIN
NC1518118025Medicare NSC
NC1518118025Medicare Oscar/Certification