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General NPI Number Information
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NPI Number | 1063309359
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Entity Type | Organization
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Legal Business Name | ADVANCED NUTRITION LLC
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Dates
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Enumeration Date | 06/20/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 843 E MAIN ST STE 303
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City | MEDFORD
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State | OR
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Zip | 97504-7137
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Country | US
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Telephone | 458-299-6858
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Fax | 541-972-8826
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Provider Business Mailing Address
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Address Line | 16 GENEVA ST
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City | MEDFORD
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State | OR
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Zip | 97504-7110
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Country | US
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Telephone | 775-870-2251
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Fax |
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Authorized Official
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Title or Position | OWNER/REGISTERED DIETITIAN
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Name | CARRIE ANN LAMBOURNE
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Credential | RDN
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Telephone | 775-870-2251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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