Provider Demographics
NPI:1700425063
Name:MICHELLE SPEARMAN NUTRITION LLC
Entity Type:Organization
Organization Name:MICHELLE SPEARMAN NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SPEARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN
Authorized Official - Phone:636-346-1672
Mailing Address - Street 1:407 OLD CENTRAL RD APT 1
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-3137
Mailing Address - Country:US
Mailing Address - Phone:636-346-1672
Mailing Address - Fax:
Practice Address - Street 1:407 OLD CENTRAL RD APT 1
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-3137
Practice Address - Country:US
Practice Address - Phone:636-346-1672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty