Healthcare Provider Details

I. General information

NPI: 1164025391
Provider Name (Legal Business Name): HASTINGS NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7378 PARK HEIGHTS AVE
PIKESVILLE MD
21208-5436
US

IV. Provider business mailing address

7378 PARK HEIGHTS AVE
BALTIMORE MD
21208-5436
US

V. Phone/Fax

Practice location:
  • Phone: 410-205-6061
  • Fax:
Mailing address:
  • Phone: 414-975-8672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name: TZIPORA D. HASTINGS
Title or Position: CEO, REGISTERED DIETITIAN
Credential: RDN
Phone: 443-983-1770