Provider Demographics
NPI:1306069489
Name:FUELING PERFORMANCE, LLC
Entity type:Organization
Organization Name:FUELING PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITION CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ZEHETNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RD,CSCS
Authorized Official - Phone:612-242-1391
Mailing Address - Street 1:701 ADDISON ALCOVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-8539
Mailing Address - Country:US
Mailing Address - Phone:612-242-1391
Mailing Address - Fax:651-998-0836
Practice Address - Street 1:225 SMITH AVE N STE 301
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2534
Practice Address - Country:US
Practice Address - Phone:651-288-5180
Practice Address - Fax:651-288-5188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2214133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty