Provider Demographics
NPI:1780111401
Name:DIABETES AND NUTRITION LLC
Entity type:Organization
Organization Name:DIABETES AND NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RD, CDE
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-345-6919
Mailing Address - Street 1:PO BOX 4787
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-4787
Mailing Address - Country:US
Mailing Address - Phone:808-345-6919
Mailing Address - Fax:
Practice Address - Street 1:75-184 HUALALAI RD STE 203
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1719
Practice Address - Country:US
Practice Address - Phone:808-329-9211
Practice Address - Fax:808-329-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI836581133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1558540914OtherNPI