Provider Demographics
NPI:1851015465
Name:WHOLESOME NUTRITION LLC
Entity Type:Organization
Organization Name:WHOLESOME NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ZAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLAHAUT
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:217-781-2127
Mailing Address - Street 1:1809 SPRING CT
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60081-8644
Mailing Address - Country:US
Mailing Address - Phone:217-781-2127
Mailing Address - Fax:
Practice Address - Street 1:1809 SPRING CT
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:IL
Practice Address - Zip Code:60081-8644
Practice Address - Country:US
Practice Address - Phone:217-781-2127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty