# RELATE NUTRITION & THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073171534
- **Authorized official:** NICOLE WAVRA MPH, RD, LD (OWNER)
- **Authorized official phone:** (651) 216-6555

## Contact information

- **Practice address:** 79 13TH AVE NE, SUITE 103B, MINNEAPOLIS, MN 55413
- **Practice address phone:** (651) 216-6555
- **Mailing address:** 79 13TH AVE NE, SUITE 103B, MINNEAPOLIS, MN 55413
- **Mailing address phone:** (651) 216-6555

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |
| 133V00000X | Registered Dietitian | — | NULL | — |
| 133V00000X | Registered Dietitian | — | — | — |

## Other

- **Enumeration date:** 05/30/2019
- **Last updated:** 05/30/2019