Organization
GRAY SPACE NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORTNEY LARSEN RDN (OWNER, DIETITIAN)
(231) 519-0273
Entity
Organization
Contact information
Practice address
2747 4 MILE RD NW, GRAND RAPIDS, MI 49544-9207
(231) 519-0273
Mailing address
2747 4 MILE RD NW, GRAND RAPIDS, MI 49544-9207
(231) 519-0273
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
05/09/2024
Last updated
05/09/2024
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