Provider Demographics
NPI:1396986311
Name:NUTRITION FOR LIFE LLC
Entity type:Organization
Organization Name:NUTRITION FOR LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KASPER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:810-625-9686
Mailing Address - Street 1:10336 N LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-8559
Mailing Address - Country:US
Mailing Address - Phone:810-625-9686
Mailing Address - Fax:
Practice Address - Street 1:5092 W VIENNA RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-2803
Practice Address - Country:US
Practice Address - Phone:810-625-9686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty