Provider Demographics
NPI:1265146518
Name:PORTER NUTRITION, LLC
Entity type:Organization
Organization Name:PORTER NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN/LLC OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RD
Authorized Official - Phone:302-750-7726
Mailing Address - Street 1:1208 WOODSVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GARNET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19060-2119
Mailing Address - Country:US
Mailing Address - Phone:302-750-7726
Mailing Address - Fax:888-695-6040
Practice Address - Street 1:1208 WOODSVIEW DR
Practice Address - Street 2:
Practice Address - City:GARNET VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19060-2119
Practice Address - Country:US
Practice Address - Phone:302-750-7726
Practice Address - Fax:888-695-6040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1083918197OtherPERSONAL NPI