Provider Demographics
NPI:1598137077
Name:PERSONALIZED NUTRITION & WELLNESS, LLC
Entity Type:Organization
Organization Name:PERSONALIZED NUTRITION & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LUANNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:941-747-9984
Mailing Address - Street 1:2424 MANATEE AVE W
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-4954
Mailing Address - Country:US
Mailing Address - Phone:941-747-9984
Mailing Address - Fax:941-794-0417
Practice Address - Street 1:2424 MANATEE AVE W
Practice Address - Street 2:SUITE 105
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-4954
Practice Address - Country:US
Practice Address - Phone:941-747-9984
Practice Address - Fax:941-794-0417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty