Provider Demographics
NPI:1700177979
Name:PERSONAL NUTRITION SOLUTIONS, LLC
Entity Type:Organization
Organization Name:PERSONAL NUTRITION SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:248-252-3856
Mailing Address - Street 1:22158 W VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2298
Mailing Address - Country:US
Mailing Address - Phone:248-252-3856
Mailing Address - Fax:
Practice Address - Street 1:22158 W VILLAGE DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2298
Practice Address - Country:US
Practice Address - Phone:248-252-3856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI995418133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty