Provider Demographics
NPI:1821567595
Name:NOURISHME NUTRITION LLC
Entity Type:Organization
Organization Name:NOURISHME NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGAHEY
Authorized Official - Suffix:
Authorized Official - Credentials:RC
Authorized Official - Phone:207-205-1101
Mailing Address - Street 1:25 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3511
Mailing Address - Country:US
Mailing Address - Phone:207-205-1101
Mailing Address - Fax:
Practice Address - Street 1:79 MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-5811
Practice Address - Country:US
Practice Address - Phone:207-205-1101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-25
Last Update Date:2018-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty