Provider Demographics
NPI:1992403257
Name:MORNING BIRD NUTRITION
Entity type:Organization
Organization Name:MORNING BIRD NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVENHALL
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:631-786-2557
Mailing Address - Street 1:PO BOX 121
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:ME
Mailing Address - Zip Code:04551-0121
Mailing Address - Country:US
Mailing Address - Phone:631-219-8929
Mailing Address - Fax:
Practice Address - Street 1:17 WILL BUTLER LANE
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:ME
Practice Address - Zip Code:04551-0455
Practice Address - Country:US
Practice Address - Phone:631-219-8929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty