Provider Demographics
NPI:1780291559
Name:OMNIHEALTH NUTRITION
Entity type:Organization
Organization Name:OMNIHEALTH NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NYLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KREINER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:214-608-6202
Mailing Address - Street 1:5315 ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-7418
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5313 ROSS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-7418
Practice Address - Country:US
Practice Address - Phone:214-286-2151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-25
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty