Provider Demographics
NPI:1295860781
Name:PRIMARY NUTRITION SPECIALISTS, INC.
Entity Type:Organization
Organization Name:PRIMARY NUTRITION SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SEKULA
Authorized Official - Suffix:
Authorized Official - Credentials:RD,LDN
Authorized Official - Phone:815-464-9735
Mailing Address - Street 1:733 SPRUCE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1039
Mailing Address - Country:US
Mailing Address - Phone:815-464-9735
Mailing Address - Fax:815-464-9735
Practice Address - Street 1:733 SPRUCE RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1039
Practice Address - Country:US
Practice Address - Phone:815-464-9735
Practice Address - Fax:815-464-9735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Single Specialty