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General NPI Number Information
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NPI Number | 1326994807
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Entity Type | Organization
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Legal Business Name | NEW VINE NUTRITION LLC
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Dates
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Enumeration Date | 03/07/2026
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Last Update Date | 03/07/2026
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Provider Practice Location Address
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Address Line | 1428 44TH ST SW
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City | WYOMING
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State | MI
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Zip | 49509-4312
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Country | US
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Telephone | 616-385-1091
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Fax |
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Provider Business Mailing Address
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Address Line | 235 140TH AVE
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City | WAYLAND
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State | MI
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Zip | 49348-9700
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Country | US
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Telephone | 616-385-1091
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | RACHAEL VANNETTE
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Credential | MS, RDN, CLS
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Telephone | 616-286-2245
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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 |
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License Number State |
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