Provider Demographics
NPI:1821426602
Name:ILIVEWELL NUTRITION THERAPY, LLC
Entity Type:Organization
Organization Name:ILIVEWELL NUTRITION THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KREBS-HOLM
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:512-789-8400
Mailing Address - Street 1:2001 PARKER LN APT 106
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-3844
Mailing Address - Country:US
Mailing Address - Phone:512-789-8400
Mailing Address - Fax:
Practice Address - Street 1:2001 PARKER LN APT 106
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-3844
Practice Address - Country:US
Practice Address - Phone:512-789-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86047572133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty