Provider Demographics
NPI:1720286420
Name:NUTRITION REALITY LLC
Entity Type:Organization
Organization Name:NUTRITION REALITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KORSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LD
Authorized Official - Phone:440-349-3873
Mailing Address - Street 1:32700 S ROUNDHEAD DR
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-4738
Mailing Address - Country:US
Mailing Address - Phone:440-349-2280
Mailing Address - Fax:440-349-5878
Practice Address - Street 1:3690 ORANGE PL
Practice Address - Street 2:SUITE 230
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4464
Practice Address - Country:US
Practice Address - Phone:440-349-3873
Practice Address - Fax:440-349-5878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1487616801OtherNPI NUMBER FOR INDIVIDUAL
OH000000532607OtherANTHEM BC & BS
OH1487616801OtherNPI NUMBER FOR INDIVIDUAL