Provider Demographics
NPI:1811546815
Name:NUTRIMENTAL HEALTHCARE LLC
Entity Type:Organization
Organization Name:NUTRIMENTAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:T
Authorized Official - Last Name:ENGELKE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:920-642-3971
Mailing Address - Street 1:4321 W COLLEGE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-3968
Mailing Address - Country:US
Mailing Address - Phone:920-642-3971
Mailing Address - Fax:844-848-8201
Practice Address - Street 1:4321 W COLLEGE AVE STE 200
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3968
Practice Address - Country:US
Practice Address - Phone:920-642-3971
Practice Address - Fax:844-848-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty