Provider Demographics
NPI:1740518638
Name:NUTRITION BY JOEY, LLC
Entity type:Organization
Organization Name:NUTRITION BY JOEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:SJOSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:702-878-5639
Mailing Address - Street 1:10961 SHALLOW WATER CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-8721
Mailing Address - Country:US
Mailing Address - Phone:702-878-5639
Mailing Address - Fax:480-247-4491
Practice Address - Street 1:8275 S EASTERN AVE
Practice Address - Street 2:SUITE #118
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2591
Practice Address - Country:US
Practice Address - Phone:702-878-5639
Practice Address - Fax:480-247-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA844423133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty