Provider Demographics
NPI:1972077519
Name:PRACTICAL NUTRITION LLC
Entity type:Organization
Organization Name:PRACTICAL NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DI STEFANO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:682-999-5835
Mailing Address - Street 1:3401 STATE HIGHWAY 34 S
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-5128
Mailing Address - Country:US
Mailing Address - Phone:682-999-5835
Mailing Address - Fax:817-476-6133
Practice Address - Street 1:2911 MEDLIN DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2330
Practice Address - Country:US
Practice Address - Phone:575-644-3568
Practice Address - Fax:817-476-6133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty