OrganizationActive
Life Stage Nutrition LLC
NPI 1629935929 · Registered Dietitian · Lakeville, MN
Provider details
- NPI number
- 1629935929
- Entity type
- Organization
- Primary specialty
- Registered DietitianDietary & Nutritional Service Providers
- Organization subpart
- No
- Authorized official
- Kyle Anderson, Founder(651) 243-0924
Specialties & taxonomies
Dietary & Nutritional Service Providers
Profile Score
Established profile(53/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
Under 1 yr in registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
17450 Gettysburg Way
Lakeville, MN 55044-4006
Phone: (651) 243-0924
Street-level locationGet directions
Mailing address
310 1/2 Main St S
Stillwater, MN 55082-5126
Registry dates
- Enumerated
- 2026-01-07
- Last updated
- 2026-02-05
- Certified
- 2026-02-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.