Provider Demographics
NPI:1013508886
Name:PEACEFUL & POWERFUL NUTRITION, LLC
Entity Type:Organization
Organization Name:PEACEFUL & POWERFUL NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, LEAD DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, RYT-200
Authorized Official - Phone:734-419-3549
Mailing Address - Street 1:17418 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4802
Mailing Address - Country:US
Mailing Address - Phone:734-419-3549
Mailing Address - Fax:
Practice Address - Street 1:17418 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-4802
Practice Address - Country:US
Practice Address - Phone:734-419-3549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty