Healthcare Provider Details

I. General information

NPI: 1063243285
Provider Name (Legal Business Name): GENTLE NUTRITION WITH GINA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5899 S WHEELER RD
MAPLE CITY MI
49664
US

IV. Provider business mailing address

PO BOX 332
MAPLE CITY MI
49664-0332
US

V. Phone/Fax

Practice location:
  • Phone: 231-735-8155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GINA SELLINGER
Title or Position: OWNER
Credential: MPH, RDN
Phone: 231-735-8155