Provider Demographics
NPI:1720734239
Name:INNER PATH NUTRITION, PLC
Entity Type:Organization
Organization Name:INNER PATH NUTRITION, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:BORGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, CD
Authorized Official - Phone:269-455-9199
Mailing Address - Street 1:2483 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:VT
Mailing Address - Zip Code:05444-9728
Mailing Address - Country:US
Mailing Address - Phone:269-455-9199
Mailing Address - Fax:
Practice Address - Street 1:2483 CAMBRIDGE RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:VT
Practice Address - Zip Code:05444-9728
Practice Address - Country:US
Practice Address - Phone:269-455-9199
Practice Address - Fax:888-971-4148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty