Provider Demographics
NPI:1881331817
Name:NUTRITION AMBITIONS
Entity type:Organization
Organization Name:NUTRITION AMBITIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD LDN
Authorized Official - Phone:708-446-4355
Mailing Address - Street 1:6830 W WINDING TRL UNIT 102
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-5216
Mailing Address - Country:US
Mailing Address - Phone:708-446-4355
Mailing Address - Fax:
Practice Address - Street 1:6830 W WINDING TRL UNIT 102
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-5216
Practice Address - Country:US
Practice Address - Phone:708-446-4355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty