Provider Demographics
NPI:1013728229
Name:VITAL STARTS NUTRITION AND LACTATION LLC
Entity type:Organization
Organization Name:VITAL STARTS NUTRITION AND LACTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:TERENZONI
Authorized Official - Suffix:
Authorized Official - Credentials:RD, IBCLC
Authorized Official - Phone:401-451-5684
Mailing Address - Street 1:38 PROCTOR CIR
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2822
Mailing Address - Country:US
Mailing Address - Phone:401-451-5684
Mailing Address - Fax:
Practice Address - Street 1:38 PROCTOR CIR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2822
Practice Address - Country:US
Practice Address - Phone:401-451-5684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty