Organization
DIVINE NUTRITION SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE GENENE HAMILTON RDLD (OWNER/EXECUTIVE DIRECTOR)
(314) 732-2302
Entity
Organization
Contact information
Practice address
2080 CORDOBA DR, FLORISSANT, MO 63033-2807
(314) 732-2302
Mailing address
2080 CORDOBA DR, FLORISSANT, MO 63033-2807
(314) 732-2302
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134657208
—
MO
Enumeration date
06/01/2017
Last updated
02/03/2021
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