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General NPI Number Information
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NPI Number | 1154847721
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Entity Type | Organization
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Legal Business Name | INTEGRAL NUTRITION, LLC
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 08/16/2017
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Provider Practice Location Address
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Address Line | 59 BALTIMORE AVENUE
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106
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Country | US
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Telephone | 207-558-3433
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Fax |
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Provider Business Mailing Address
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Address Line | 59 BALTIMORE AVE
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-4451
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MADELINE HOWARD
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Credential | MS, RD, LD
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Telephone | 207-558-3433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DI1270
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License Number State | ME
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