Provider Demographics
NPI:1982194890
Name:ALYSSA BAKER NUTRITION LLC
Entity Type:Organization
Organization Name:ALYSSA BAKER NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD
Authorized Official - Phone:815-693-5110
Mailing Address - Street 1:9241 BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8326
Mailing Address - Country:US
Mailing Address - Phone:815-693-5110
Mailing Address - Fax:
Practice Address - Street 1:21200 S LAGRANGE RD # 232
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-2003
Practice Address - Country:US
Practice Address - Phone:815-693-5110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty