Provider Demographics
NPI:1497592968
Name:CRUA NUTRITION LLC
Entity type:Organization
Organization Name:CRUA NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:KISLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-254-5639
Mailing Address - Street 1:14 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02770-1832
Mailing Address - Country:US
Mailing Address - Phone:508-254-5639
Mailing Address - Fax:
Practice Address - Street 1:74 FAUNCE CORNER RD STE 630
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1209
Practice Address - Country:US
Practice Address - Phone:508-254-5639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty