Organization
MEDICAL NUTRITION THERAPISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA RAE HASELHORST R.D., L.D.N. (MEMBER)
(618) 401-7675
Entity
Organization
Contact information
Practice address
510 N HARRISON ST, TRENTON, IL 62293-1070
(618) 401-7675
Mailing address
510 N HARRISON ST, TRENTON, IL 62293-1070
(618) 401-7675
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
IL
Other
Enumeration date
09/05/2007
Last updated
09/15/2007
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