Provider Demographics
NPI:1649989005
Name:STRIDE NUTRITION AND LIFESTYLE SERVICES LLC
Entity type:Organization
Organization Name:STRIDE NUTRITION AND LIFESTYLE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOLEEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LDN
Authorized Official - Phone:618-267-3012
Mailing Address - Street 1:427 IL 185
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-3437
Mailing Address - Country:US
Mailing Address - Phone:618-267-3012
Mailing Address - Fax:
Practice Address - Street 1:2203 W JEFFERSON ST STE A
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-1465
Practice Address - Country:US
Practice Address - Phone:618-267-3012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty