Provider Demographics
NPI:1942397773
Name:CORE NUTRITION, LLC
Entity Type:Organization
Organization Name:CORE NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:937-260-9548
Mailing Address - Street 1:269 ANNETTE DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-2230
Mailing Address - Country:US
Mailing Address - Phone:937-260-9548
Mailing Address - Fax:
Practice Address - Street 1:269 ANNETTE DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-2230
Practice Address - Country:US
Practice Address - Phone:937-260-9548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5736133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty