Provider Demographics
NPI:1073109245
Name:THE NUTRITION COLLECTIVE L.L.C.
Entity Type:Organization
Organization Name:THE NUTRITION COLLECTIVE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANNA-GOUIN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:248-310-0257
Mailing Address - Street 1:2283 SHEVLIN ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1176
Mailing Address - Country:US
Mailing Address - Phone:248-310-0257
Mailing Address - Fax:
Practice Address - Street 1:2283 SHEVLIN ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1176
Practice Address - Country:US
Practice Address - Phone:248-310-0257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty