Provider Demographics
NPI:1700605953
Name:KIDNEY CARE NUTRITION LLC
Entity type:Organization
Organization Name:KIDNEY CARE NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:GULLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MPP, RDN
Authorized Official - Phone:312-515-9398
Mailing Address - Street 1:11497 NORWAY DR
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353-3436
Mailing Address - Country:US
Mailing Address - Phone:312-515-9398
Mailing Address - Fax:
Practice Address - Street 1:11497 NORWAY DR
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353-3436
Practice Address - Country:US
Practice Address - Phone:312-515-9398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-05
Last Update Date:2024-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty