Provider Demographics
NPI:1992049365
Name:IN-TUNE WELLNESS LLC
Entity type:Organization
Organization Name:IN-TUNE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN- OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:612-354-6625
Mailing Address - Street 1:2110 FREMONT AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4018
Mailing Address - Country:US
Mailing Address - Phone:612-354-6625
Mailing Address - Fax:
Practice Address - Street 1:4422 WHITE BEAR AVE N
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3475
Practice Address - Country:US
Practice Address - Phone:612-354-6625
Practice Address - Fax:651-342-8044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2776133V00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty