Provider Demographics
NPI:1932634557
Name:NUTRITION FOR A LIFETIME
Entity Type:Organization
Organization Name:NUTRITION FOR A LIFETIME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:757-288-2195
Mailing Address - Street 1:2501 WINDY RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-1532
Mailing Address - Country:US
Mailing Address - Phone:757-288-2195
Mailing Address - Fax:
Practice Address - Street 1:2501 WINDY RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-1532
Practice Address - Country:US
Practice Address - Phone:757-288-2195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service