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General NPI Number Information
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NPI Number | 1336641299
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Entity Type | Individual
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Provider Name | MILLENNIA RUTH LYTLE ND, CNS
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Gender | Female
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Dates
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Enumeration Date | 03/06/2018
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Last Update Date | 03/06/2018
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Provider Practice Location Address
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Address Line | 135 CLARKSON AVE F8
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City | BROOKLYN
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State | NY
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Zip | 11226
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Country | US
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Telephone | 844-441-9661
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Fax | 888-255-5088
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Provider Business Mailing Address
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Address Line | 135 CLARKSON AVE F8
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City | BROOKLYN
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State | NY
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Zip | 11226
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Country | US
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Telephone | 844-441-9661
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Fax | 888-255-5088
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | CNS16383
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 0057
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License Number State | DC
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