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General NPI Number Information
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NPI Number | 1841098753
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Entity Type | Organization
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Legal Business Name | ISLAND NUTRITION, PLLC
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 720 SE PIONEER WAY
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City | OAK HARBOR
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State | WA
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Zip | 98277-5752
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Country | US
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Telephone | 360-544-2466
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Fax | 360-873-0017
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Provider Business Mailing Address
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Address Line | 418 SW JUDSON DR
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City | OAK HARBOR
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State | WA
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Zip | 98277-5802
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Country | US
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Telephone | 360-544-2466
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Fax | 360-873-0017
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHANNON GRUBE
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Credential | MS, RDN, CD
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Telephone | 360-544-2466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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