Provider Demographics
NPI:1750008132
Name:HEALTHFUL LANE NUTRITION LLC
Entity type:Organization
Organization Name:HEALTHFUL LANE NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:785-458-2954
Mailing Address - Street 1:2900 UNIVERSITY AVE SE APT 305
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3734
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2900 UNIVERSITY AVE SE APT 305
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-3734
Practice Address - Country:US
Practice Address - Phone:785-458-2954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty