Provider Demographics
NPI:1336265800
Name:EVOLUTION NUTRITION INC.
Entity Type:Organization
Organization Name:EVOLUTION NUTRITION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:SNOW
Authorized Official - Last Name:DELCONTE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:401-396-9331
Mailing Address - Street 1:450 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:SUITE 8C
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-5300
Mailing Address - Country:US
Mailing Address - Phone:401-396-9331
Mailing Address - Fax:401-396-9369
Practice Address - Street 1:450 VETERANS MEMORIAL PKWY
Practice Address - Street 2:SUITE 8C
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-5300
Practice Address - Country:US
Practice Address - Phone:401-396-9331
Practice Address - Fax:401-396-9369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty