Provider Demographics
NPI:1689194201
Name:NUTRITION 365
Entity type:Organization
Organization Name:NUTRITION 365
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:COSTANZO
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:781-858-2500
Mailing Address - Street 1:236 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03037-1105
Mailing Address - Country:US
Mailing Address - Phone:781-858-2500
Mailing Address - Fax:
Practice Address - Street 1:236 NORTH RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:NH
Practice Address - Zip Code:03037-1105
Practice Address - Country:US
Practice Address - Phone:781-858-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0631133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty