Provider Demographics
NPI:1497454201
Name:HOMEGROWN NUTRITION
Entity Type:Organization
Organization Name:HOMEGROWN NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:EMERICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LD
Authorized Official - Phone:484-626-0758
Mailing Address - Street 1:820 W HIND DR UNIT 240343
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96824-1813
Mailing Address - Country:US
Mailing Address - Phone:484-626-0758
Mailing Address - Fax:484-379-0069
Practice Address - Street 1:820 W HIND DR UNIT 240343
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96824-1813
Practice Address - Country:US
Practice Address - Phone:484-626-0758
Practice Address - Fax:484-379-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-01
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1457092827OtherDIETITIAN