NPIMap

Organization Active NPI

LG Nutrition LLC

Doing business as Summerfield Custom Wellness

  • Registered Dietitian
  • Wilmington, NC
National Provider Identifier
1164857231
Registry record updated Apr 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
L004173 Issued in NC
Legal business name
LG NUTRITION LLC
Doing business as
Summerfield Custom Wellness
Practice address
1209 Market St
Suite J
Wilmington, NC 28401-4345
Phone
(910) 663-5166
NPI assigned
Sep 9, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2021

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

Authorized official

Name
Laura Renee Greenhow BransfieldNPI 1629412119
Title
Owner
Phone
(910) 663-5166

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
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X L004173 NC Primary

Addresses

Primary practice location

1209 Market St
Suite J
Wilmington, NC 28401-4345

Mailing address

8801 Fast Park Dr Ste 213
Raleigh, NC 27617-4853
Phone (919) 442-8398

Other practice location 1

8801 Fast Park Dr Ste 213
Raleigh, NC 27617-4853
Phone (919) 442-8398

Other names 1

  • Summerfield Custom Wellness Doing business as

National Provider Directory

National Provider Directory

Locations

8801 Fast Park Dr
Ste 213
Raleigh, NC 27617
Phone (919) 442-8398

5129 Oleander Dr
Ste 103
Wilmington, NC 28403
Phone (910) 663-5166

1209 Market St
Ste J
Wilmington, NC 28401
Phone (910) 663-5166

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1378684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619481600000",
    "number": "1164857231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8801 FAST PARK DR STE 213",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276174853",
            "telephone_number": "919-442-8398",
            "fax_number": "888-856-3502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1209 MARKET ST",
            "address_2": "SUITE J",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284014345",
            "telephone_number": "910-663-5166"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8801 Fast Park Dr Ste 213",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276174853",
            "country_code": "US",
            "telephone_number": "919-442-8398",
            "fax_number": "888-856-3502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LG NUTRITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-09",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-27",
        "status": "A",
        "authorized_official_last_name": "GREENHOW BRANSFIELD",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-663-5166"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "NC",
            "license": "L004173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summerfield Custom Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Summerfield Custom Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 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.