MEDICARE: PRACTICAL NUTRITION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1972077519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRACTICAL NUTRITION LLC

Provider Business Mailing Address
First Line	:	3401 STATE HIGHWAY 34 S
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75402-5128
Country	:	US
Telephone Number	:	682-999-5835
Fax Number	:	817-476-6133

Provider Business Practice Location Address
First Line	:	2911 MEDLIN DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-2330
Country	:	US
Telephone Number	:	575-644-3568
Fax Number	:	817-476-6133

Authorized Official
Title or Position	:	OWNER
Name	:	HEATHER DI STEFANO
Credential	:	MS, RD
Telephone Number	:	682-999-5835

Provider Enumeration Date	:	01/16/2019
Last Update Date	:	11/14/2024

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Directions to “PRACTICAL NUTRITION LLC ” Practice Location

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