Life Stage Nutrition LLC
Dietitian, Registered in Lakeville, MN. Organization (NPI-2).
NPI number1629935929
StatusActive
Last updated in NPPESFeb 5, 2026
Details
- NPI
- 1629935929
- Entity type
- Organization (NPI-2)
- Legal business name
- Life Stage Nutrition LLC
- Organization subpart
- No
- Enumeration date
- Jan 7, 2026
- Certification date
- Feb 5, 2026
- Last updated
- Feb 5, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 133V00000X | Dietitian, Registered | – | – | Yes |
Practice location
17450 Gettysburg WayLakeville, MN 55044-4006
Phone 651-243-0924
Mailing address
310 1/2 Main St SStillwater, MN 55082-5126
Phone 651-243-0924
Authorized official
Kyle Robert Anderson
Founder
6512430924
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