Provider Demographics
NPI:1053563593
Name:NUTRITION 1ST
Entity type:Organization
Organization Name:NUTRITION 1ST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:NST
Authorized Official - Phone:810-333-2872
Mailing Address - Street 1:11994 HYNE RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-9234
Mailing Address - Country:US
Mailing Address - Phone:810-333-2872
Mailing Address - Fax:248-601-2217
Practice Address - Street 1:11994 HYNE RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-9234
Practice Address - Country:US
Practice Address - Phone:810-333-2872
Practice Address - Fax:248-601-2217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI833070133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty