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General NPI Number Information
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NPI Number | 1013725340
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Entity Type | Organization
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Legal Business Name | PERSONAL NUTRITION & WELLNESS INC
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 4655 LANNON AVE NE
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City | SAINT MICHAEL
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State | MN
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Zip | 55376-4613
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Country | US
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Telephone | 763-300-4816
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Fax | 763-299-1002
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Provider Business Mailing Address
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Address Line | 4655 LANNON AVE NE
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City | SAINT MICHAEL
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State | MN
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Zip | 55376-4613
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Country | US
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Telephone | 763-300-4816
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Fax | 763-299-1002
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | TIFFANY FLATEN
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Credential | CNS, LN
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Telephone | 763-300-4816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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