Provider Demographics
NPI:1740495431
Name:PERSONAL NUTRITION, INC
Entity type:Organization
Organization Name:PERSONAL NUTRITION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:512-745-0868
Mailing Address - Street 1:PO BOX 203098
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78720-3098
Mailing Address - Country:US
Mailing Address - Phone:512-745-0868
Mailing Address - Fax:
Practice Address - Street 1:11673 JOLLYVILLE RD STE 202
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4211
Practice Address - Country:US
Practice Address - Phone:512-745-0868
Practice Address - Fax:866-372-0980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty