Provider Demographics
NPI:1356593941
Name:LAVANWAY NUTRITION LLC
Entity type:Organization
Organization Name:LAVANWAY NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:LAVANWAY
Authorized Official - Suffix:
Authorized Official - Credentials:RD,LD
Authorized Official - Phone:207-862-2303
Mailing Address - Street 1:2A CONSTITUTION AVE
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1330
Mailing Address - Country:US
Mailing Address - Phone:207-862-2303
Mailing Address - Fax:207-862-2303
Practice Address - Street 1:2A CONSTITUTION AVE
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:ME
Practice Address - Zip Code:04444-1330
Practice Address - Country:US
Practice Address - Phone:207-862-2303
Practice Address - Fax:207-862-2303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty