Provider Demographics
NPI:1376381715
Name:NOURISHED AND NEUTRAL LLC
Entity type:Organization
Organization Name:NOURISHED AND NEUTRAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, CD
Authorized Official - Phone:385-307-6111
Mailing Address - Street 1:441 N 1220 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-2440
Mailing Address - Country:US
Mailing Address - Phone:385-307-6111
Mailing Address - Fax:
Practice Address - Street 1:441 N 1220 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-2440
Practice Address - Country:US
Practice Address - Phone:385-307-6111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty