Provider Demographics
NPI:1013725340
Name:PERSONAL NUTRITION & WELLNESS INC
Entity type:Organization
Organization Name:PERSONAL NUTRITION & WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLATEN
Authorized Official - Suffix:
Authorized Official - Credentials:CNS, LN
Authorized Official - Phone:763-300-4816
Mailing Address - Street 1:4655 LANNON AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-4613
Mailing Address - Country:US
Mailing Address - Phone:763-300-4816
Mailing Address - Fax:763-299-1002
Practice Address - Street 1:4655 LANNON AVE NE
Practice Address - Street 2:
Practice Address - City:SAINT MICHAEL
Practice Address - State:MN
Practice Address - Zip Code:55376-4613
Practice Address - Country:US
Practice Address - Phone:763-300-4816
Practice Address - Fax:763-299-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty