Organization
GUT GLOW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNDA FLAVIA LAWRENCE RDN, LDN (LEAD DIETITIAN)
(650) 248-4863
Entity
Organization
Contact information
Practice address
411 CONGRESS ST, PORTLAND, ME 04101-3505
(650) 248-4863
Mailing address
635 W 170TH ST APT 2E, NEW YORK, NY 10032-3226
(650) 248-4863
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
133VN1004X
Pediatric Nutrition Registered Dietitian
—
—
133VN1005X
Renal Nutrition Registered Dietitian
—
—
133VN1006X
Metabolic Nutrition Registered Dietitian
—
—
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
—
—
133VN1501X
Sports Dietetics Nutrition Registered Dietitian
—
—
Other
Enumeration date
12/04/2023
Last updated
12/04/2023
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