Provider Demographics
NPI:1699516633
Name:ACTIVE NUTRITION LLC
Entity type:Organization
Organization Name:ACTIVE NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH RDN
Authorized Official - Phone:248-459-1508
Mailing Address - Street 1:32988 THORNDYKE CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1969
Mailing Address - Country:US
Mailing Address - Phone:248-459-1508
Mailing Address - Fax:248-742-4993
Practice Address - Street 1:32988 THORNDYKE CT
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1969
Practice Address - Country:US
Practice Address - Phone:248-459-1508
Practice Address - Fax:248-742-4993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty