Healthcare Provider Details

I. General information

NPI: 1568051100
Provider Name (Legal Business Name): ECNUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2021
Last Update Date: 08/17/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 W MAPLE RD STE 108
BLOOMFIELD HILLS MI
48301-3118
US

IV. Provider business mailing address

240 MILLRACE RD
BIRMINGHAM MI
48009-3837
US

V. Phone/Fax

Practice location:
  • Phone: 248-563-6866
  • Fax:
Mailing address:
  • Phone: 248-563-6866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: EMILY H CAMIENER
Title or Position: SOLE MBR
Credential: RDN
Phone: 248-563-6866