MEDICARE: LIFE PURSUITS NUTRITION COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1649040999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE PURSUITS NUTRITION COUNSELING LLC

Provider Business Mailing Address
First Line	:	492 PASO FINO ST
Second Line	:
City	:	ROBINSON
State	:	TX
Zip	:	76706-7640
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	492 PASO FINO ST
Second Line	:
City	:	ROBINSON
State	:	TX
Zip	:	76706-7640
Country	:	US
Telephone Number	:	806-642-3733
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SAVANNA LITTLE
Credential	:	LD, RD
Telephone Number	:	806-642-3733

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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