Provider Demographics
NPI:1891594636
Name:MAGNOLIA NUTRITION LLC
Entity type:Organization
Organization Name:MAGNOLIA NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELINORE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MDA, RDN, LDN
Authorized Official - Phone:978-394-5107
Mailing Address - Street 1:37 JOHN ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-2124
Mailing Address - Country:US
Mailing Address - Phone:978-394-5107
Mailing Address - Fax:
Practice Address - Street 1:37 JOHN ST UNIT 1
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-2124
Practice Address - Country:US
Practice Address - Phone:978-394-5107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty