Provider Demographics
NPI:1831781558
Name:REDEFINED NUTRITION, LLC
Entity type:Organization
Organization Name:REDEFINED NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN
Authorized Official - Phone:704-221-7183
Mailing Address - Street 1:4920 BENTRIDGE DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-2826
Mailing Address - Country:US
Mailing Address - Phone:704-221-7183
Mailing Address - Fax:
Practice Address - Street 1:4920 BENTRIDGE DR NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-2826
Practice Address - Country:US
Practice Address - Phone:704-221-7183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty