Provider Demographics
NPI:1942017009
Name:PLANT-BASED DIETITIANS INC
Entity type:Organization
Organization Name:PLANT-BASED DIETITIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MADELEINE ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTAINE REID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:514-688-9908
Mailing Address - Street 1:5830 EAST 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609
Mailing Address - Country:US
Mailing Address - Phone:514-688-9908
Mailing Address - Fax:
Practice Address - Street 1:5830 EAST 2ND STREET
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609
Practice Address - Country:US
Practice Address - Phone:514-688-9908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty