Provider Demographics
NPI:1730537267
Name:CUPP NUTRITION SERVICES, INC
Entity type:Organization
Organization Name:CUPP NUTRITION SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITAN
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUPP
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:815-464-9734
Mailing Address - Street 1:733 SPRUCE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1039
Mailing Address - Country:US
Mailing Address - Phone:815-263-4402
Mailing Address - Fax:815-464-9734
Practice Address - Street 1:733 SPRUCE RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1039
Practice Address - Country:US
Practice Address - Phone:815-263-4402
Practice Address - Fax:815-464-9734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.000250133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty