Provider Demographics
NPI:1851302145
Name:NUTRITION WORKS,LLC
Entity Type:Organization
Organization Name:NUTRITION WORKS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:QUIMBY
Authorized Official - Suffix:
Authorized Official - Credentials:RD,LD
Authorized Official - Phone:207-772-6279
Mailing Address - Street 1:805 STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2626
Mailing Address - Country:US
Mailing Address - Phone:207-772-6279
Mailing Address - Fax:207-772-6279
Practice Address - Street 1:805 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2626
Practice Address - Country:US
Practice Address - Phone:207-772-6279
Practice Address - Fax:207-772-6279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MENUMT0866Medicare ID - Type Unspecified