NPIMap

Organization Active NPI

Lawrence Nutrition Clinic LLC

  • Nutrition Education Nutritionist
  • Bloomington, IL
National Provider Identifier
1144984287
Registry record updated Oct 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nutrition Education NutritionistTaxonomy code 133NN1002X
Legal business name
LAWRENCE NUTRITION CLINIC LLC
Doing business as
Lawrence Nutrition Clinic
Practice address
1203 Morrissey Dr Ste B
Bloomington, IL 61701-7510
Phone
(309) 590-6791
NPI assigned
Oct 25, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Javelin M Lawrence, CNSCNPI 1831853969
Title
Owner
Phone
(309) 590-6791

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nutrition Education NutritionistGroup: 193400000X SINGLE SPECIALTY GROUP 133NN1002X Primary

Addresses

Primary practice location

1203 Morrissey Dr Ste B
Bloomington, IL 61701-7510

Mailing address

1203 Morrissey Dr Ste B
Bloomington, IL 61701-7510
Phone (309) 590-6791

Other names 1

  • Lawrence Nutrition Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

1203 Morrissey Dr
Ste B
Bloomington, IL 61701
Phone (309) 590-6791

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635120000000",
    "number": "1144984287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 MORRISSEY DR STE B",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017510",
            "telephone_number": "309-590-6791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 MORRISSEY DR STE B",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017510",
            "telephone_number": "309-590-6791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAWRENCE NUTRITION CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-25",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "JAVELIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-590-6791",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CNSC"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lawrence Nutrition Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.