Healthcare Provider Details

I. General information

NPI: 1851039358
Provider Name (Legal Business Name): GRIT CITY NUTRITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 BROADWAY
TACOMA WA
98402-3907
US

IV. Provider business mailing address

539 BROADWAY
TACOMA WA
98402-3907
US

V. Phone/Fax

Practice location:
  • Phone: 253-254-5476
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA ROSSI
Title or Position: OWNER/PROVIDER
Credential: MS, CN
Phone: 253-254-5476