Healthcare Provider Details

I. General information

NPI: 1730012733
Provider Name (Legal Business Name): EAT TO GROW NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 WINTER ST
WHITMAN MA
02382-2518
US

IV. Provider business mailing address

115 WINTER ST
WHITMAN MA
02382-2518
US

V. Phone/Fax

Practice location:
  • Phone: 508-423-0580
  • Fax:
Mailing address:
  • Phone: 508-423-0580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: KELLY MARIE IGO
Title or Position: DIETITIAN/OWNER
Credential: RD, MS
Phone: 508-423-0580