Healthcare Provider Details

I. General information

NPI: 1851302145
Provider Name (Legal Business Name): NUTRITION WORKS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 STEVENS AVE
PORTLAND ME
04103-2626
US

IV. Provider business mailing address

805 STEVENS AVE
PORTLAND ME
04103-2626
US

V. Phone/Fax

Practice location:
  • Phone: 207-772-6279
  • Fax: 207-772-6279
Mailing address:
  • Phone: 207-772-6279
  • Fax: 207-772-6279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUSAN A. QUIMBY
Title or Position: MANAGER
Credential: R.D.,L.D.
Phone: 207-772-6279