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Organization
LAWRENCE NUTRITION CLINIC LLC
Active
Organization
LAWRENCE NUTRITION CLINIC LLC
Active
Other names
Lawrence Nutrition Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JAVELIN M LAWRENCE CNSC (OWNER)
(309) 590-6791
Entity
Organization
Contact information
Practice address
1203 MORRISSEY DR STE B, BLOOMINGTON, IL 61701-7510
(309) 590-6791
Mailing address
1203 MORRISSEY DR STE B, BLOOMINGTON, IL 61701-7510
(309) 590-6791
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
Other
Enumeration date
10/25/2021
Last updated
10/25/2021
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