Provider Demographics
NPI:1447970322
Name:TRIUNE NUTRITION LLC
Entity type:Organization
Organization Name:TRIUNE NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-205-9137
Mailing Address - Street 1:5633 N MARVINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-4115
Mailing Address - Country:US
Mailing Address - Phone:267-205-9137
Mailing Address - Fax:
Practice Address - Street 1:5633 N MARVINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-4115
Practice Address - Country:US
Practice Address - Phone:267-205-9137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1265165708OtherINDIVIDUAL NPI