| NPI | 1669234381 |
|---|---|
| Doing Business As | GREAT LAKES NUTRITION |
| Entity Type | Organization |
| Authorized Contact | JESSICA ELAINE LAKE Registered Dietitian 814-580-8808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Enumeration Date | 2024-01-29 |
| Last Update Date | 2024-09-25 |