Provider Demographics
NPI:1174947253
Name:ADVANCED NUTRITION, LLC
Entity type:Organization
Organization Name:ADVANCED NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFERRIERE
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:781-642-1250
Mailing Address - Street 1:32 SOUTH ST
Mailing Address - Street 2:UNIT 300
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3594
Mailing Address - Country:US
Mailing Address - Phone:781-642-1250
Mailing Address - Fax:781-207-6415
Practice Address - Street 1:32 SOUTH ST
Practice Address - Street 2:UNIT 300
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-3594
Practice Address - Country:US
Practice Address - Phone:781-642-1250
Practice Address - Fax:781-207-6415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2334133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty