Provider Demographics
NPI:1972859239
Name:NORTH STAR NUTRITION LLC
Entity Type:Organization
Organization Name:NORTH STAR NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARICE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOORN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:469-263-9099
Mailing Address - Street 1:555 REPUBLIC DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5481
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:555 REPUBLIC DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5481
Practice Address - Country:US
Practice Address - Phone:469-263-9099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81306133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty