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General NPI Number Information
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NPI Number | 1508689142
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Entity Type | Organization
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Legal Business Name | MINDFUEL NUTRITION
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 2B S WASHINGTON ST
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City | OXFORD
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State | MI
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Zip | 48371-4971
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Country | US
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Telephone | 248-834-0614
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Fax |
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Provider Business Mailing Address
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Address Line | 53218 MICHAEL DR
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City | CHESTERFIELD
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State | MI
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Zip | 48047-6117
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Country | US
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Telephone | 586-206-5981
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Fax |
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Authorized Official
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Title or Position | DIETITIAN
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Name | HANNAH DISBROW
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Credential | RDN
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Telephone | 586-206-5981
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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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