Provider Demographics
NPI:1265078950
Name:ADVANCED NUTRITION SOLUTIONS
Entity type:Organization
Organization Name:ADVANCED NUTRITION SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:LOWELL
Authorized Official - Last Name:HOLSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-951-7030
Mailing Address - Street 1:213 STEWART ACRES
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213-9716
Mailing Address - Country:US
Mailing Address - Phone:304-951-7030
Mailing Address - Fax:
Practice Address - Street 1:213 STEWART ACRES
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:WV
Practice Address - Zip Code:25213-9716
Practice Address - Country:US
Practice Address - Phone:304-951-7030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLSTON HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty