Healthcare Provider Details

I. General information

NPI: 1558730960
Provider Name (Legal Business Name): NUTRITIONAL HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N RICHMOND ST STE F
APPLETON WI
54911-4602
US

IV. Provider business mailing address

400 N RICHMOND ST STE F
APPLETON WI
54911-4602
US

V. Phone/Fax

Practice location:
  • Phone: 920-358-5764
  • Fax:
Mailing address:
  • Phone: 920-358-5764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY BAEHMAN
Title or Position: CLINICAL NUTRITIONIST/OWNER
Credential: M.S.
Phone: 920-358-5764