MEDICARE: PERSONAL NEWTRITION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	804238	OH

General Provider Information

NPI Number	:	1225094493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSONAL NEWTRITION LLC

Provider Business Mailing Address
First Line	:	3012 GLENMORE AVE
Second Line	:	SUITE 14
City	:	CINCINNATI
State	:	OH
Zip	:	45238-2269
Country	:	US
Telephone Number	:	513-661-6391
Fax Number	:	513-661-6392

Provider Business Practice Location Address
First Line	:	3012 GLENMORE AVE
Second Line	:	SUITE 14
City	:	CINCINNATI
State	:	OH
Zip	:	45238-2269
Country	:	US
Telephone Number	:	513-661-6391
Fax Number	:	513-661-6392

Authorized Official
Title or Position	:	BUSINESS OWNER
Name	:	CHRISTINE MARIE O'CONNOR
Credential	:	REGISTERED DIETITIAN
Telephone Number	:	513-661-6391

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	08/22/2020

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