Healthcare Provider Details

I. General information

NPI: 1336641299
Provider Name (Legal Business Name): MILLENNIA RUTH LYTLE ND, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MILLIE LYTLE

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 CLARKSON AVE F8
BROOKLYN NY
11226
US

IV. Provider business mailing address

135 CLARKSON AVE F8
BROOKLYN NY
11226
US

V. Phone/Fax

Practice location:
  • Phone: 844-441-9661
  • Fax: 888-255-5088
Mailing address:
  • Phone: 844-441-9661
  • Fax: 888-255-5088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberCNS16383
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number0057
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: