Healthcare Provider Details

I. General information

NPI: 1467133793
Provider Name (Legal Business Name): ADRIENNE ANGELA JUSTEN RDN,LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 ARLINGTON AVE
TOLEDO OH
43614-2598
US

IV. Provider business mailing address

2622 104TH ST
TOLEDO OH
43611-2038
US

V. Phone/Fax

Practice location:
  • Phone: 419-383-4403
  • Fax:
Mailing address:
  • Phone: 419-245-8434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.5054
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberLD.5054
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberLD.5054
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: