Provider Demographics
NPI:1396180675
Name:MID OHIO NUTRITION, LLC
Entity Type:Organization
Organization Name:MID OHIO NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSHION
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:614-855-2824
Mailing Address - Street 1:1080 BEECHER XING N
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4557
Mailing Address - Country:US
Mailing Address - Phone:614-855-2824
Mailing Address - Fax:
Practice Address - Street 1:1080 BEECHER XING N
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-4557
Practice Address - Country:US
Practice Address - Phone:614-855-2824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty