Provider Demographics
NPI:1407527229
Name:WHOLISTIC NUTRITION LLC
Entity Type:Organization
Organization Name:WHOLISTIC NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASEN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:419-722-5016
Mailing Address - Street 1:3849 SILSBY CT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-3476
Mailing Address - Country:US
Mailing Address - Phone:419-722-5016
Mailing Address - Fax:
Practice Address - Street 1:3849 SILSBY CT
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-3476
Practice Address - Country:US
Practice Address - Phone:419-722-5016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty