Provider Demographics
NPI:1285187195
Name:HOMEGROWN NUTRITION LLC
Entity Type:Organization
Organization Name:HOMEGROWN NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CSO, CD
Authorized Official - Phone:262-945-0186
Mailing Address - Street 1:2101 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-3805
Mailing Address - Country:US
Mailing Address - Phone:262-945-0186
Mailing Address - Fax:
Practice Address - Street 1:2101 MAIN ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-3805
Practice Address - Country:US
Practice Address - Phone:262-945-0186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2787133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty