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General NPI Number Information
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NPI Number | 1497682488
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Entity Type | Organization
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Legal Business Name | MARIENDA NUTRITION LLC
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Dates
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Enumeration Date | 05/05/2026
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Last Update Date | 05/05/2026
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Provider Practice Location Address
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Address Line | 1828 W ELLEN ST APT 2
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City | CHICAGO
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State | IL
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Zip | 60622-3373
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Country | US
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Telephone | 608-426-4851
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Fax |
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Provider Business Mailing Address
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Address Line | 1828 W ELLEN ST APT 2
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City | CHICAGO
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State | IL
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Zip | 60622-3373
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Country | US
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Telephone | 608-426-4851
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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 KALLGREN
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Credential | RDN, LDN
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Telephone | 608-426-4851
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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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