Provider Demographics
NPI:1013541606
Name:IMAGINE NUTRITION LLC
Entity Type:Organization
Organization Name:IMAGINE NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:724-388-5804
Mailing Address - Street 1:218 N DALLAS AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15208-2309
Mailing Address - Country:US
Mailing Address - Phone:724-388-5804
Mailing Address - Fax:888-764-9766
Practice Address - Street 1:218 N DALLAS AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15208-2309
Practice Address - Country:US
Practice Address - Phone:724-388-5804
Practice Address - Fax:888-764-9766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty