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General NPI Number Information
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NPI Number | 1407701477
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Entity Type | Organization
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Legal Business Name | THE PINES NUTRITION THERAPY LLC
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 1372 E 1200 NORTH RD
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City | ONARGA
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State | IL
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Zip | 60955-7534
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Country | US
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Telephone | 815-471-7808
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Fax |
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Provider Business Mailing Address
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Address Line | 1372 E 1200 NORTH RD
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City | ONARGA
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State | IL
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Zip | 60955-7534
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Country | US
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Telephone | 815-471-7808
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Fax |
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Authorized Official
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Title or Position | DIETITIAN/OWNER
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Name | ASHLEY NICOLE PETERS
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Credential | RDN
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Telephone | 815-471-7808
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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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