Healthcare Provider Details

I. General information

NPI: 1891316808
Provider Name (Legal Business Name): LIVEEATPERFORM NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28333 POST ROCK CIR
FIRTH NE
68358-6226
US

IV. Provider business mailing address

28333 POST ROCK CIR
FIRTH NE
68358-6226
US

V. Phone/Fax

Practice location:
  • Phone: 402-239-5759
  • Fax:
Mailing address:
  • Phone: 402-239-5759
  • 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: LINDSEY REMMERS
Title or Position: OWNER, REGISTERED DIETITIAN
Credential: MS, RD, CSSD, LMNT
Phone: 402-239-5759