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General NPI Number Information
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NPI Number | 1861185886
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Entity Type | Organization
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Legal Business Name | DAISY TREE NUTRITION LLC
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Dates
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Enumeration Date | 05/26/2023
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 9417 BROADVIEW RD
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City | BROADVIEW HEIGHTS
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State | OH
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Zip | 44147-2307
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Country | US
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Telephone | 833-516-0454
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Fax | 888-972-7994
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Provider Business Mailing Address
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Address Line | 548 ANDOVER CIR
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City | BROADVIEW HEIGHTS
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State | OH
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Zip | 44147-4251
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Country | US
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Telephone | 440-781-7236
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER/REGISTERED DIETITIAN
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Name | ALEXANDRA VITANZA
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Credential | MS, RDN, LD
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Telephone | 440-781-7236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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