Provider Demographics
NPI:1700480803
Name:SPRING DAWN NUTRITION, LLC
Entity Type:Organization
Organization Name:SPRING DAWN NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANAE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINIKIN
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:385-244-9573
Mailing Address - Street 1:828 W 4350 S
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84405-3426
Mailing Address - Country:US
Mailing Address - Phone:385-244-9573
Mailing Address - Fax:385-240-6209
Practice Address - Street 1:828 W 4350 S
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:UT
Practice Address - Zip Code:84405-3426
Practice Address - Country:US
Practice Address - Phone:385-244-9573
Practice Address - Fax:385-240-6209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1881248698OtherNPI 1