Provider Demographics
NPI:1629318696
Name:RENU NUTRITION CONSULTANTS LLC
Entity Type:Organization
Organization Name:RENU NUTRITION CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:PIEPER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, RD, CSR
Authorized Official - Phone:810-923-5600
Mailing Address - Street 1:12745 S. SAGINAW RD.
Mailing Address - Street 2:SUITE 806-177
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2437
Mailing Address - Country:US
Mailing Address - Phone:810-923-5600
Mailing Address - Fax:810-396-6882
Practice Address - Street 1:12745 S. SAGINAW RD.
Practice Address - Street 2:SUITE 806-177
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2437
Practice Address - Country:US
Practice Address - Phone:810-923-5600
Practice Address - Fax:810-396-6882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI888931133V00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6985Medicare UPIN