Healthcare Provider Details

I. General information

NPI: 1134710627
Provider Name (Legal Business Name): POLARIS NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 BELFORD RD
HOLLY MI
48442-9503
US

IV. Provider business mailing address

3410 BELFORD RD
HOLLY MI
48442-9503
US

V. Phone/Fax

Practice location:
  • Phone: 248-390-6663
  • Fax:
Mailing address:
  • Phone: 248-390-6663
  • 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: CHRISTINA SCHUMANN
Title or Position: OWNER/REGISTERED DIETITIAN
Credential: RD
Phone: 248-390-6663