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General NPI Number Information
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NPI Number | 1952052763
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Entity Type | Organization
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Legal Business Name | DONNAFIT4LIFE LLC
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | 3332 N 78TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53222-3920
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Country | US
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Telephone | 414-866-2522
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Fax |
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Provider Business Mailing Address
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Address Line | 3332 N 78TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53222-3920
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Country | US
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Telephone | 414-866-2522
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Fax |
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Authorized Official
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Title or Position | OWNER- AND PROVIDER
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Name | LADONNA GLADNEY
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Credential | NDTR, CPT
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Telephone | 866-252-2989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 136A00000X
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Taxonomy Name | Registered Dietetic Technician
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License Number |
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License Number State |
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