Provider Demographics
NPI:1205899911
Name:THE NUTRITION CONNECTION, LLC
Entity type:Organization
Organization Name:THE NUTRITION CONNECTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND HEAD PROVIDER OF ABOVE CO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPASTEPHANOU
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RD,LDN,CD5
Authorized Official - Phone:410-321-5050
Mailing Address - Street 1:PO BOX 36144
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-6144
Mailing Address - Country:US
Mailing Address - Phone:410-321-5050
Mailing Address - Fax:410-321-5050
Practice Address - Street 1:515 FAIRMOUNT AVE
Practice Address - Street 2:STE 340
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5466
Practice Address - Country:US
Practice Address - Phone:410-321-5050
Practice Address - Fax:410-321-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDN00262133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD16NUOtherBLUE CROSS BLUE SHIELD MD
MD974RMedicare ID - Type Unspecified