Provider Demographics
NPI:1508573544
Name:SUNRISE INTEGRATIVE NUTRITION LLC
Entity Type:Organization
Organization Name:SUNRISE INTEGRATIVE NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMPAGNE-LANGABEER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RDN
Authorized Official - Phone:281-744-0744
Mailing Address - Street 1:3606 WOODHEAD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-1621
Mailing Address - Country:US
Mailing Address - Phone:281-744-0744
Mailing Address - Fax:
Practice Address - Street 1:2503 ROBINHOOD ST STE 160
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-2534
Practice Address - Country:US
Practice Address - Phone:281-317-0490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty