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NPI Code Detail

MEDICARE: HEALTHENUTRIFIT LLC

MEDICARE: HEALTHENUTRIFIT 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
12255A2300XAthletic Trainer
2172V00000XCommunity Health Worker
3133V00000XRegistered Dietitian

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1400A2PAOTHERMNBCBS OF MN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225207343
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEALTHENUTRIFIT LLC
Provider Business Mailing Address
First Line : 2282 FIELD STONE DRIVE
Second Line :
City : MENDOTA HEIGHTS
State : MN
Zip : 55120-1918
Country : US
Telephone Number : 651-592-7830
Fax Number : 651-405-3850
Provider Business Practice Location Address
First Line : 750 MAIN ST
Second Line : SUITE 100
City : MENDOTA HEIGHTS
State : MN
Zip : 55118-3764
Country : US
Telephone Number : 651-592-7830
Fax Number : 651-405-3850
Authorized Official
Title or Position : CEO/LICENSED RD
Name : MRS. SUSAN MARIANNE PARKS
Credential : RD, CSSD,LN
Telephone Number : 651-592-7830
Provider Enumeration Date : 02/22/2008
Last Update Date : 02/01/2013

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Directions to “HEALTHENUTRIFIT LLC ” Practice Location

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