MEDICARE: NUTRITIONAL HEALING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133NN1002X	Nutrition Education Nutritionist

General Provider Information

NPI Number	:	1558730960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUTRITIONAL HEALING LLC

Provider Business Mailing Address
First Line	:	400 N RICHMOND ST STE F
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54911-4602
Country	:	US
Telephone Number	:	920-358-5764
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N RICHMOND ST STE F
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54911-4602
Country	:	US
Telephone Number	:	920-358-5764
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL NUTRITIONIST/OWNER
Name	:	KIMBERLY BAEHMAN
Credential	:	M.S.
Telephone Number	:	920-358-5764

Provider Enumeration Date	:	09/16/2015
Last Update Date	:	09/16/2015

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