Provider Demographics
NPI:1265909154
Name:NUTRIFORMANCE
Entity type:Organization
Organization Name:NUTRIFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-609-6835
Mailing Address - Street 1:10407 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:FRONTENAC
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10407 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:FRONTENAC
Practice Address - State:MO
Practice Address - Zip Code:63131-2909
Practice Address - Country:US
Practice Address - Phone:314-432-6103
Practice Address - Fax:314-692-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health