Organization
LIVE WELL NUTRITION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NIKOLE BARRETT RDN, CD (PRESIDENT)
(574) 217-8372
Entity
Organization
Contact information
Practice address
229 E OMER AVE, MISHAWAKA, IN 46545-6345
(574) 217-8372
Mailing address
229 E OMER AVE, MISHAWAKA, IN 46545-6345
(574) 217-8372
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37001744A
IN
133VN1005X
Renal Nutrition Registered Dietitian
37001744A
IN
Other
Enumeration date
07/30/2014
Last updated
07/30/2014
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