Provider Demographics
NPI:1841975588
Name:FEED THE WOLF WEIGHTLIFTING & NUTRITION LLC
Entity type:Organization
Organization Name:FEED THE WOLF WEIGHTLIFTING & NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSSELIN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:802-498-3381
Mailing Address - Street 1:740 E 3RD ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-4515
Mailing Address - Country:US
Mailing Address - Phone:802-498-3381
Mailing Address - Fax:
Practice Address - Street 1:740 E 3RD ST APT 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-4515
Practice Address - Country:US
Practice Address - Phone:802-498-3381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty