Provider Demographics
NPI:1619219631
Name:EASTSIDE NUTRITION LLC
Entity Type:Organization
Organization Name:EASTSIDE NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERRED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RD,CSSD
Authorized Official - Phone:520-618-5383
Mailing Address - Street 1:333 N WILMOT RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2631
Mailing Address - Country:US
Mailing Address - Phone:520-618-5383
Mailing Address - Fax:520-918-3031
Practice Address - Street 1:333 N WILMOT RD
Practice Address - Street 2:SUITE 340
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2631
Practice Address - Country:US
Practice Address - Phone:520-618-5383
Practice Address - Fax:520-918-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty