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1033977418 NPI number — NUTRAEVOLUTION DIETETICS

NPI Number: 1033977418
Health Care Provider/Practitioner: NUTRAEVOLUTION DIETETICS

Information about “1033977418” NPI (NUTRAEVOLUTION DIETETICS) exists in 1033977418 in HTML format HTML  |  1033977418 in plain Text format TXT  |  1033977418 in PDF (Portable Document Format) PDF  |  1033977418 in an XML format XML  formats.

NPI Number : 1033977418 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1033977418",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "NUTRAEVOLUTION DIETETICS",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2872 ALASKAN WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JACKSONVILLE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32226-5847",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "815-993-1080",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2872 ALASKAN WAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JACKSONVILLE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32226-5847",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "815-993-1080",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/11/2024",
    "LastUpdateDate": "03/11/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ALVEY-DZIERZYNSKI",
    "AuthorizedOfficialFirstName": "JENNIFER",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO/DIETITIAN",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "RD, LDN",
    "AuthorizedOfficialTelephoneNumber": "815-993-1080",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261Q00000X",
        "TaxonomyName": "Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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